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ISSN 1527-3172 (Electronic)

2009, Number 1

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MEDICC Review 2009; 11 (1)

Neurofunctional evaluation strategy for presurgical selection of temporal lobe epilepsy patients

Morales CLM, Sánchez CC, Bender JE, Bosch BJ, García ME, García MI, Lorigados PL, Estupiñán DB, Trápaga QO, Báez MM, Sánchez CA, Pérez MD, Guevara M, Zaldívar BM, Águila Á

Language: English
References: 46
Page: 29-35
PDF size: 277.32 Kb.


ABSTRACT

Introduction Temporal lobe epilepsy (TLE) is the prototype of a surgically correctable syndrome. Successful surgical outcomes depend on a thorough presurgical evaluation aimed primarily at identifying the epileptogenic zone.
Objective Describe the noninvasive presurgical selection and evaluation strategy for TLE patients introduced at the International Neurological Restoration Center (CIREN) in Havana, Cuba, and evaluated between 2001 and 2006 for its accuracy in identifying candidates for non-lesional resection surgery.
Methods Ictal onset electrographic patterns of 1,679 seizures in 72 patients with drug-resistant partial epilepsy, obtained through longterm scalp Video EEG (V-EEG) monitoring, were evaluated. The correlation between the V-EEG-defined epileptogenic zone and the dysfunction shown by single photon emission computed tomography (ictal and interictal brain SPECT) and nuclear magnetic resonance spectroscopy (MRS) was established.
Results V-EEG monitoring determined that 44.4% of evaluated patients had complex partial temporal lobe seizures. Identification of patients with medial temporal epilepsy (MTE) increased as a result of lateralization and localization of the dominant mean ictal pattern frequency (5.56 ± 1.31 Hz) during the period of maximum spectral power VARETA localization of an ictal epileptiform activity source coincided with the epileptogenic zone in all TLE patients who subsequently underwent a successful temporal lobectomy. Semiquantitative analysis of ictal and interictal brain SPECT images, as well as metabolic ratios measured by MRS, combined with V-EEG findings, enabled localization/lateralization of the epileptogenic zone in TLE patients whose MRIs were normal or showed bilateral structural abnormalities.
Conclusions Confirmation of correct localization/lateralization of the epileptogenic zone following successful surgical outcomes in selected TLE patients led CIREN to develop a surgical treatment strategy for patients in Cuba with drug-resistant temporal lobe epilepsy. This strategy offers an appropriate, cost-effective treatment alternative for developing countries like Cuba, with the benefit of significantly improving TLE patients’ quality of life.


REFERENCES

  1. Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporallobe epilepsy. N Engl J Med. 2001;345:311-8.

  2. Deacon C, Wiebe S, Blume WT, McLachlan RS, Young GB, Matijevic S. Seizure identification by clinical description in temporal lobe epilepsy: How accurate are we? Neurology. 2003;61:1686-9.

  3. Wieser HG. Mesial temporal lobe epilepsy versus amygdalar epilepsy: late seizure recurrence after initially successful amygdalotomy and regained seizure control following hippocampectomy. Epileptic Disord. 2000;2:141-52.

  4. Li LM, Cendes F, Antel SB, Andermann F, Serles W, Dubeau F, et al. Prognostic value of proton magnetic resonance spectroscopic imaging for surgical outcome in patients with intractable temporal lobe epilepsy and bilateral hippocampal atrophy. Ann Neurol. 2000;47:195-200.

  5. Hennessy MJ, Elwes RD, Honavar M, Rabe- Hesketh S, Binnie CD, Polkey CE. Predictors of outcome and pathological considerations in the surgical treatment of intractable epilepsy associated with temporal lobe lesions. J Neurol Neurosurg Psychiatry. 2001;7:450-8.

  6. Wieser HG, Blume WT, Fish D, Goldensohn E, Hufnagel A, King D, et al. ILAE Commission Report. Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia. 2001;42:282-6.

  7. Spencer S, Huh L. Outcomes of epilepsy surgery in adults and children. Lancet Neurol. 2008 Jun;7(6):525.

  8. Schwartz TH, Marks D, Pak J, Hill J, Mandelbaum DE, Holodny AI, et al. Standardization of amygdalohippocampectomy with intraoperative magnetic resonance imaging: preliminary experience. Epilepsia. 2002;43:430-6.

  9. Sun ZR, Kim MA, Heo KCh, Min K. Relationship between bilateral temporal hypometabolism and EEG findings for mesial temporal lobe epilepsy: Analysis of (18)F-FDG PET using SPM. Seizure. 2006;15(1):56-63.

  10. Kim JH, Im KC, Kim JS, Lee SA, Lee JK, Khang SK, et al. Ictal hyperperfusion patterns in relation to ictal scalp EEG patterns in patients with unilateral hippocampal sclerosis: a SPECT study. Epilepsia. 2007 Feb;48(2):270-7.

  11. Yilmazer-Hanke DM, Wolf HK, Schramm J, Elger CE, Wiestler OD, Blumcke I. Subregional pathology of the amygdala complex and entorhinal region in surgical specimens from patients with pharmacoresistant temporal lobe epilepsy. J Neuropathol Exp Neurol. 2000;59:907-20.

  12. Pitkanen A, Sutula TP. Is epilepsy a progressive disorder? Prospects for new therapeutic approaches in temporal-lobe epilepsy. Lancet Neurol. 2002;1:173-81.

  13. Bernasconi A, Martinez V, Rosa-Neto P, D’Agostino D, Bernasconi N, Berkovic S, et al. Surgical resection for intractable epilepsy in “double cortex” syndrome yields inadequate results. Epilepsia. 2001;42:1124-9.

  14. Engel Jr J. Mesial temporal lobe epilepsy: what have we learned? Neuroscientist. 2001;7:340-52.

  15. Devinsky O. Diagnosis and treatment of temporal lobe epilepsy. Rev Neurol Dis. 2004;1(1):2-9.

  16. Engel Jr J. Finally, a randomized, controlled trial of epilepsy surgery. N Engl J Med. 2001;345:365-7.

  17. Prevedello DM, Sandmann MC, Ebner A. Prognostic factors in mesial temporal lobe epilepsy surgery. Arq Neuropsiquiatr. 2000;58:207-13.

  18. Alarcón G, Kissani N, Dad M, Elwes RD, Ekanayake J, Hennessy MJ, et al. Lateralizing and localizing values of ictal onset recorded on the scalp: evidence from simultaneous recordings with intracranial foramen ovale electrodes. Epilepsia. 2001;42:1426-37.

  19. Pacia S, Devinsky O, Perrine K, Ravdin L, Luciano D, Vázquez B, et al. Clinical features of neocortical temporal lobe epilepsy. Ann Neurol. 1996;4:724-30.

  20. Foldvary N, Nashold B, Mascha E, Thompson EA, Lee N, McNamara JO, et al. Seizure outcome after temporal lobectomy for temporal lobe epilepsy: a Kaplan-Meier survival analysis. Neurology. 2000;54:630-4.

  21. Zijlmans M, Huiskamp GM, van Huffelen AC, Spetgens WP, Leijten FS. Detection of temporal lobe spikes: Comparing nasopharyngeal, cheek and anterior temporal electrodes to simultaneous subdural recordings. Clin Neurophysiol. 2008 Aug;119(8):1771-7.

  22. Pacia SV, Ebersole JS. Intracranial EEG in temporal lobe epilepsy. J Clin Neurophysiol. 1999;16:399-407.

  23. Blanke O, Lantz G, Seeck M, Spinelli L, Grave DP, Thut G, et al. Temporal and spatial determination of EEG-seizure onset in the frequency domain. Clin Neurophysiol. 2000;111:763-72.

  24. Ragazzo PC, Galanopoulou AS. Alfentanilinduced activation: a promising tool in the presurgical evaluation of temporal lobe epilepsy patients. Brain Res Rev. 2000;32:316-27.

  25. Bosch-Bayard J, Valdés-Sosa P, Virues-Alba T, Aubert-Vázquez E, John ER, Harmony T, et al. 3D statistical parametric mapping of EEG source spectra by means of variable resolution electromagnetic tomography (VARETA). Clin Electroencephalogr. 2001;32(2):47-61.

  26. Weder BJ, Schindler K, Loher TJ, Wiest R, Wissmeyer M, Ritter P, et al. Brain areas involved in medial temporal lobe seizures: a principal component analysis of ictal SPECT data. Hum Brain Mapp. 2006 Jun;27(6):520-34.

  27. Lamy C, Derambure P, Josien E, Destee A, Vermesch P, Leduc V, et al. Factors playing a role in the increase of localized perfusion observed by single-photon emission-computed tomography during an epileptic seizur. Rev Neurol (Paris). 2000;156:1113-9.

  28. Holmes MD, Miles AN, Dodrill CB, Ojemann GA, Wilensky AJ. Identifying potential surgical candidates in patients with evidence of bitemporal epilepsy. Epilepsia. 2003;44:1075-9.

  29. Spencer SS. When should temporal-lobe epilepsy be treated surgically? Lancet Neurol. 2002;1:375-82.

  30. Hardy SG, Miller JW, Holmes MD, Born DE, Ojemann GA, Dodrill CB, et al. Factors predicting outcome of surgery for intractable epilepsy with pathologically verified mesial temporal sclerosis. Epilepsia. 2003;44:565-8.

  31. So EL. Integration of EEG, MRI, and SPECT in localizing the seizure focus for epilepsy surgery. Epilepsia. 2000;41 Suppl 3:S48-54.

  32. Salanova V, Andermann F, Rasmussen T, Olivier A, Quesney LF. Parietal lobe epilepsy. Clinical manifestations and outcome in 82 patients treated surgically between 1929 and 1988. Brain. 1995;118:607-27.

  33. Quesney LF. Preoperative electroencephalographic investigation in frontal lobe epilepsy: electroencephalographic and electrocorticographic recordings. Can J Neurol Sci. 1991;18:559-63.

  34. Chang BS, Ives JR, Schomer DL, Drislane FW. Outpatient EEG monitoring in the presurgical evaluation of patients with refractory temporal lobe epilepsy. J Clin Neurophysiol. 2002;19:152-6.

  35. Battiston JJ, Darcey TM, Siegel AM, Williamson PD, Barkan HI, Akay M, et al. Statistical mapping of scalp-recorded ictal EEG records using wavelet analysis. Epilepsia. 2003;44:664-72.

  36. Quesney LF, Risinger MW, Shewmon DA. Extracranial EEG evaluation. In: Surgical treatment of the epilepsies. New York: Raven Press; 1993. p. 173-95.

  37. Risinger MW, Engel J Jr, Van Ness PC, Henry TR, Crandall P. Ictal localization of temporal lobe seizures with scalp/sphenoidal recordings. Neurology. 1989;39:1288-93.

  38. Ebersole JS, Pacia S. Localization of Temporal Lobe Foci by Ictal EEG Patterns. Epilepsia. 1996;37:386-99.

  39. Nelissen N, Van Paesschen W, Baete K, Van Laere K, Palmini A, Van Billoen H, et al. Correlations of interictal FDG-PET metabolism and ictal SPECT perfusion changes in human temporal lobe epilepsy with hippocampal sclerosis. Neuroimage. 2006 Aug 15;32(2):684-95.

  40. Andraus ME, Cosenza CA, Fonseca LM, Andraus CF, D’Andrea I, Alves-Leon SV. Interictal brain SPECT in patients with medically refractory temporal lobe epilepsy. Arq Neuropsiquiatr. 2002;60:779-87.

  41. Rowe CC, Berkovic SF, Austin MC, Saling M, Kalnins RM, McKay WJ, et al. Visual and quantitative analysis of interictal SPECT with technetium-99m-HMPAO in temporal lobe epilepsy. J Nucl Med. 1991;32:1688-94.

  42. Chang DJ, Zubal IG, Gottschalk C, Necochea A, Stokking R, Studholme C, et al. Comparison of statistical parametric mapping and SPECT difference imaging in patients with temporal lobe epilepsy. Epilepsia. 2002;43:68-74.

  43. Van Paesschen W, Dupont P, Van Driel G, Van Billoen H, Maes A. SPECT perfusion changes during complex partial seizures in patients with hippocampal sclerosis. Brain. 2003;126:1103-11.

  44. McNally KA, Paige AL, Varghese G, Zhang H, Novotny EJ Jr, Spencer SS, et al. Localizing value of ictal-interictal SPECT analyzed by SPM (ISAS). Epilepsia. 2005 Sep;46(9):1450-64.

  45. Leite CC, Lucato LT, Sato JR, Valente KD, Otaduy MC. Multivoxel proton MR spectroscopy in malformations of cortical development. Am J Neuroradiol. 2007;28(6):1071-5.

  46. Breiter SN, Arroyo S, Mathews VP, Lesser RP, Bryan RN, Barker PB. Proton MR spectroscopy in patients with seizure disorders. Am J Neuroradiol. 1994;15:373-84.




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