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Temporopolar blurring in temporal lobe epilepsy with hippocampal sclerosis and long-term prognosis after epilepsy surgery.
Epilepsy Res 2015; 112:76-83ER

Abstract

PURPOSE

We conducted a retrospective study in order to investigate the clinical significance of temporopolar grey/white matter abnormalities (GWMA) in patients with temporal lobe epilepsy (TLE) and unilateral hippocampal sclerosis (HS) with a long post-surgical follow-up.

METHODS

The study comprised 122 consecutive patients with medically refractory TLE and unilateral HS who underwent epilepsy surgery and had a minimum postoperative follow-up of 5 years. Patients were divided into two groups, based on findings of pre-surgical MRI: group 1 with GWMA and 2 with normal signal and grey/white matter definition in temporal pole. Demographic and clinical data were reviewed and compared between groups.

RESULTS

GWMA were found in 52.5% of patients, always ipsilateral to HS. Compared with group 2, group 1 patients had earlier epilepsy onset (mean, 9.3 vs 14.4 years, P=0.001), a higher occurrence of first seizure ≤2 years of age (25.8% vs 10.5%, P=0.036; OR=2.96 [95% CI=1.07-8.19]), and greater prevalence of left HS (76.6% vs 43.1%, P<0.001; OR=4.31 [95% CI=1.98-9.38]). No differences were found in gender, presence or type of initial precipitating injury, history of secondary generalized seizures, duration of epilepsy, seizure frequency before surgery, neuropsychological evaluation and presence or lateralization of pre-surgical interictal epileptiform discharges. Postoperative follow-up varied from 5 to 11.5 years (mean 7.4) and was similar in both groups (P=0.155). The proportion of patients classified as seizure-free (Engel class I) at last follow-up in groups 1 and 2 were 73.4% and 69%, respectively (P=0.689). Similarly, the percentages of seizure-free patients with no antiepileptic drugs at last evaluation were not different between groups (P=0.817). In logistic regression analysis, left HS (P=0.001; OR=4.166 [95% CI=1.86-9.34]) and age at epilepsy onset ≤2 years (P=0.047; OR=3.885 [95% CI=1.86-17.50]) were independently associated with risk of having GWMA.

CONCLUSION

GWMA are frequent findings in patients with TLE and HS, and may help lateralize the epileptogenic zone. Our data support the hypothesis that GWMA are caused by seizure-related insults during the critical period of cerebral myelination. GWMA did not influence the postoperative seizure outcome of patients with TLE and HS, even after an extended duration of post-surgical follow-up.

Authors+Show Affiliations

Department of Neurology and Neurosurgery, Division of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil. Electronic address: pevinaves@yahoo.com.br.Department of Neurology and Neurosurgery, Division of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Clinical Neurophysiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.Department of Radiology, Division of Neuroradiology, Universidade Federal de São Paulo, São Paulo, Brazil.Department of Neurology and Neurosurgery, Division of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil.Department of Neurology and Neurosurgery, Division of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil.Department of Radiology, Division of Neuroradiology, Universidade Federal de São Paulo, São Paulo, Brazil.Department of Neurology and Neurosurgery, Division of Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.Department of Neurology and Neurosurgery, Division of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25847342

Citation

Naves, Pedro V F., et al. "Temporopolar Blurring in Temporal Lobe Epilepsy With Hippocampal Sclerosis and Long-term Prognosis After Epilepsy Surgery." Epilepsy Research, vol. 112, 2015, pp. 76-83.
Naves PV, Caboclo LO, Carrete H, et al. Temporopolar blurring in temporal lobe epilepsy with hippocampal sclerosis and long-term prognosis after epilepsy surgery. Epilepsy Res. 2015;112:76-83.
Naves, P. V., Caboclo, L. O., Carrete, H., Kelmann, B. V., Gaça, L. B., Sandim, G. B., ... Yacubian, E. M. (2015). Temporopolar blurring in temporal lobe epilepsy with hippocampal sclerosis and long-term prognosis after epilepsy surgery. Epilepsy Research, 112, pp. 76-83. doi:10.1016/j.eplepsyres.2015.02.013.
Naves PV, et al. Temporopolar Blurring in Temporal Lobe Epilepsy With Hippocampal Sclerosis and Long-term Prognosis After Epilepsy Surgery. Epilepsy Res. 2015;112:76-83. PubMed PMID: 25847342.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Temporopolar blurring in temporal lobe epilepsy with hippocampal sclerosis and long-term prognosis after epilepsy surgery. AU - Naves,Pedro V F, AU - Caboclo,Luís Otávio S F, AU - Carrete,Henrique,Jr AU - Kelmann,Bruno V, AU - Gaça,Larissa B, AU - Sandim,Gabriel B, AU - Centeno,Ricardo S, AU - Yacubian,Elza Márcia T, Y1 - 2015/02/25/ PY - 2014/11/18/received PY - 2015/02/14/revised PY - 2015/02/17/accepted PY - 2015/4/8/entrez PY - 2015/4/8/pubmed PY - 2015/12/22/medline KW - Epilepsy surgery KW - Grey/white matter abnormalities KW - MRI KW - Temporal lobe epilepsy KW - Temporal pole blurring SP - 76 EP - 83 JF - Epilepsy research JO - Epilepsy Res. VL - 112 N2 - PURPOSE: We conducted a retrospective study in order to investigate the clinical significance of temporopolar grey/white matter abnormalities (GWMA) in patients with temporal lobe epilepsy (TLE) and unilateral hippocampal sclerosis (HS) with a long post-surgical follow-up. METHODS: The study comprised 122 consecutive patients with medically refractory TLE and unilateral HS who underwent epilepsy surgery and had a minimum postoperative follow-up of 5 years. Patients were divided into two groups, based on findings of pre-surgical MRI: group 1 with GWMA and 2 with normal signal and grey/white matter definition in temporal pole. Demographic and clinical data were reviewed and compared between groups. RESULTS: GWMA were found in 52.5% of patients, always ipsilateral to HS. Compared with group 2, group 1 patients had earlier epilepsy onset (mean, 9.3 vs 14.4 years, P=0.001), a higher occurrence of first seizure ≤2 years of age (25.8% vs 10.5%, P=0.036; OR=2.96 [95% CI=1.07-8.19]), and greater prevalence of left HS (76.6% vs 43.1%, P<0.001; OR=4.31 [95% CI=1.98-9.38]). No differences were found in gender, presence or type of initial precipitating injury, history of secondary generalized seizures, duration of epilepsy, seizure frequency before surgery, neuropsychological evaluation and presence or lateralization of pre-surgical interictal epileptiform discharges. Postoperative follow-up varied from 5 to 11.5 years (mean 7.4) and was similar in both groups (P=0.155). The proportion of patients classified as seizure-free (Engel class I) at last follow-up in groups 1 and 2 were 73.4% and 69%, respectively (P=0.689). Similarly, the percentages of seizure-free patients with no antiepileptic drugs at last evaluation were not different between groups (P=0.817). In logistic regression analysis, left HS (P=0.001; OR=4.166 [95% CI=1.86-9.34]) and age at epilepsy onset ≤2 years (P=0.047; OR=3.885 [95% CI=1.86-17.50]) were independently associated with risk of having GWMA. CONCLUSION: GWMA are frequent findings in patients with TLE and HS, and may help lateralize the epileptogenic zone. Our data support the hypothesis that GWMA are caused by seizure-related insults during the critical period of cerebral myelination. GWMA did not influence the postoperative seizure outcome of patients with TLE and HS, even after an extended duration of post-surgical follow-up. SN - 1872-6844 UR - https://www.unboundmedicine.com/medline/citation/25847342/Temporopolar_blurring_in_temporal_lobe_epilepsy_with_hippocampal_sclerosis_and_long_term_prognosis_after_epilepsy_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0920-1211(15)00032-7 DB - PRIME DP - Unbound Medicine ER -