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Electro-clinical criteria and surgical outcome: Is there a difference between mesial and lesional temporal lobe epilepsy?
Acta Neurol Scand 2017; 136(6):708-714AN

Abstract

OBJECTIVES

Mesial temporal lobe epilepsy syndrome (MTLE) with specific electrophysiological and clinical characteristics and hippocampal sclerosis (HS) on MRI is considered the prototype of a syndrome with good surgical prognosis. Ictal onset zones in MTLE have been found to extend outside the hippocampus and neocortical seizures often involve mesial structures. It can, thus, be questioned whether MTLE with HS is different from lesional temporal epilepsies with respect to electro-clinical characteristics and surgical prognosis. We assessed whether MTLE with HS is distinguishable from lesional TLE and which criteria determine surgical outcome.

METHODS

People in a retrospective cohort of 389 individuals with MRI abnormalities who underwent temporal lobectomy, were divided into "HS only" or "lesional" TLEs. Twenty-six presented with dual pathology and were excluded from further analysis. We compared surgical outcome and electro-clinical characteristics.

RESULTS

Over half (61%) had "HS only." Four electro-clinical characteristics (age at epilepsy onset, febrile seizures, memory dysfunction and contralateral dystonic posturing) distinguished "HS only" from "lesional" TLE, but there was considerable overlap. Seizure freedom 2 years after surgery (Engel class 1) was similar: 67% ("HS only") vs 69% ("lesional" TLE). Neither presence of HS nor electro-clinical criteria was associated with surgical outcome.

CONCLUSIONS

Despite small differences in electrophysiological and clinical characteristics between MTLE with HS and lesional TLE, surgical outcomes are similar, indicating that aetiology seems irrelevant in the referral for temporal surgery.

Authors+Show Affiliations

Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands. Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands. NIHR University College London Hospitals, Biomedical Research Centre, UCL Institute of Neurology, London, UK. Chalfont Centre for Epilepsy, Chalfont St Peter, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28626979

Citation

Wassenaar, M, et al. "Electro-clinical Criteria and Surgical Outcome: Is There a Difference Between Mesial and Lesional Temporal Lobe Epilepsy?" Acta Neurologica Scandinavica, vol. 136, no. 6, 2017, pp. 708-714.
Wassenaar M, Leijten FSS, de Haan GJ, et al. Electro-clinical criteria and surgical outcome: Is there a difference between mesial and lesional temporal lobe epilepsy? Acta Neurol Scand. 2017;136(6):708-714.
Wassenaar, M., Leijten, F. S. S., de Haan, G. J., Uijl, S. G., & Sander, J. W. (2017). Electro-clinical criteria and surgical outcome: Is there a difference between mesial and lesional temporal lobe epilepsy? Acta Neurologica Scandinavica, 136(6), pp. 708-714. doi:10.1111/ane.12790.
Wassenaar M, et al. Electro-clinical Criteria and Surgical Outcome: Is There a Difference Between Mesial and Lesional Temporal Lobe Epilepsy. Acta Neurol Scand. 2017;136(6):708-714. PubMed PMID: 28626979.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Electro-clinical criteria and surgical outcome: Is there a difference between mesial and lesional temporal lobe epilepsy? AU - Wassenaar,M, AU - Leijten,F S S, AU - de Haan,G-J, AU - Uijl,S G, AU - Sander,J W, Y1 - 2017/06/18/ PY - 2017/05/26/accepted PY - 2017/6/20/pubmed PY - 2018/5/22/medline PY - 2017/6/20/entrez KW - epilepsy KW - neuroimaging KW - seizures KW - treatment SP - 708 EP - 714 JF - Acta neurologica Scandinavica JO - Acta Neurol. Scand. VL - 136 IS - 6 N2 - OBJECTIVES: Mesial temporal lobe epilepsy syndrome (MTLE) with specific electrophysiological and clinical characteristics and hippocampal sclerosis (HS) on MRI is considered the prototype of a syndrome with good surgical prognosis. Ictal onset zones in MTLE have been found to extend outside the hippocampus and neocortical seizures often involve mesial structures. It can, thus, be questioned whether MTLE with HS is different from lesional temporal epilepsies with respect to electro-clinical characteristics and surgical prognosis. We assessed whether MTLE with HS is distinguishable from lesional TLE and which criteria determine surgical outcome. METHODS: People in a retrospective cohort of 389 individuals with MRI abnormalities who underwent temporal lobectomy, were divided into "HS only" or "lesional" TLEs. Twenty-six presented with dual pathology and were excluded from further analysis. We compared surgical outcome and electro-clinical characteristics. RESULTS: Over half (61%) had "HS only." Four electro-clinical characteristics (age at epilepsy onset, febrile seizures, memory dysfunction and contralateral dystonic posturing) distinguished "HS only" from "lesional" TLE, but there was considerable overlap. Seizure freedom 2 years after surgery (Engel class 1) was similar: 67% ("HS only") vs 69% ("lesional" TLE). Neither presence of HS nor electro-clinical criteria was associated with surgical outcome. CONCLUSIONS: Despite small differences in electrophysiological and clinical characteristics between MTLE with HS and lesional TLE, surgical outcomes are similar, indicating that aetiology seems irrelevant in the referral for temporal surgery. SN - 1600-0404 UR - https://www.unboundmedicine.com/medline/citation/28626979/Electro_clinical_criteria_and_surgical_outcome:_Is_there_a_difference_between_mesial_and_lesional_temporal_lobe_epilepsy L2 - https://doi.org/10.1111/ane.12790 DB - PRIME DP - Unbound Medicine ER -