Artikel
Coexistent extratemporal lesions on MR imaging in patients with temporal lobe epilepsy and hippocampus sclerosis: its impact on seizure outcome after epilepsy surgery
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Autoren
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Gülsah Aydin
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Motaz Hamed
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Carlos Quesada
- Universitätsklinikum Bonn, Klinik für Epileptologie, Bonn, Deutschland
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Christian E. Elger
- Universitätsklinikum Bonn, Klinik für Epileptologie, Bonn, Deutschland
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Erdem Güresir
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Hartmut Vatter
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Valeri Borger
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Patients with temporal lobe epilepsy (TLE) are refractory to antiepileptic drugs in about 30% of all cases. A randomized clinical trial has shown that surgical treatment is superior to medical therapy for patients with refractory TLE. Especially patients with unilateral hippocampus sclerosis (uHS) have a good chance of postoperative seizure-freedom. Data regarding the surgical outcome for patients with uHS and evidence of coexistent extratemporal lesion in MRI are scarce. However, the prevailing assumption is, that the chance for seizure-freedom in these patients is decreased compared to patients with uHS only. The aim of this study was to evaluate the postoperative seizure outcome in patients with uHS and coexistent extratemporal lesions in comparison to patients with uHS only.
Methods: For this analysis we identified 54 patients with TLE and uHS as an exclusively pathology on MRI (group I) and 14 patients with TLE and uHS with additionally extratemporal lesion on MRI (group II) who were surgically treated at our institution between 11/2012 and 10/2016. All patients were presurgically assessed in the department of epileptology. The clinical charts were analyzed and compared between the two groups. The seizure outcome was assessed according ILAE at follow-up 12 months after surgery.
Results: The analysis revealed no significant difference between the two groups (group I vs. group II) regarding the distribution of gender (male: 54% vs. 43%), mean age at seizure onset (16years ± 13.5 vs. 17years ± 16), mean age at the time of surgery (40y ± 14.7 vs. 40y ± 16.7), and histopathological features (hippocampus sclerosis: 94% vs. 93%; hippocampus gliosis: 6% vs. 7%). The uHS in group II was significantly more often localized in the left hippocampus compared to group I (86% vs. 38%, p=0.0023). There was no difference in seizure-free outcome (ILAE 1) at 12 months follow-up between both groups (group I 80% vs. group II 64%, p=0.28).
Conclusion: The evidence of coexistent extratemporal lesions on MRI does not influence the postoperative seizure outcome in patients with TLE and uHS.
