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KMID : 0877219980020020134
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Journal of Korean Epilepsy Society
1998 Volume.2 No. 2 p.134 ~ p.139
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Resective Surgery without Invasive Intracranial EEG Monitoring in Patients with Temporal lobe Epilepsy
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Jung Won-Young
Orrin Devinsky
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Abstract
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Purpose : Anterior temporal lobectomy (ALT), the most common operation for intractable temporal lobe epilepsy (TLE), sometimes requires several stages of non-invasive and invasive presurgical evaluations. Various non-invasive presurgical tests can help to lateralize and/or localize the epileptogenic zone, therefore it is possible to resect epileptogenic zone without invasive intracranial studies. We performed this study in order to analyze the predictive value of the predictors of outcome after ATL.
Methods : Prior to surgery, all patients were evaluated with non-invasive scalp interictal and ictal EEG, clinical seizure semiology, MRI, intracarotid amobarbital (Wada) and neuropsychological tests. If these results were converge to one temporal lobe, we performed ATL without invasive intracranial EEG monitoring. In order to analyze the predictive value of these presurgical tests as well as the following potential predictors of outcome, we reviewed 35 patients with medically refractory epilepsy who were consecutively underwent ATL : age at the time of surgery, age at seizure onset, sex, uration of seizures, the presence of a lesion or hippocampal sclerosis in MRI. The average follow up period was 35.1±15.5 months (range 12-60 months). The outcome factors analyzed were compared to two types of outcome group ; seizure free group (Class Ⅰ) and persistent seizure group (Class Ⅱ-Ⅳ) according to Engel’s classification.
Results : Thirty (85.7%) out of 35 patients were seizure free during follow up. Only the presence of a lesion in MRI significantly predicted seizure free at the significance level of 5 percent. The presence of diffuse sclerosis including hippocampal sclerosis in MRI and the history of febrile convulsion tended to seizure free, but only at the significance level of 7 and 13 percents, respectively.
Conclusions : We conclude some intractable TLE patients, especially those who have a lesion or s hippocampal sclerosis in MRI and the history of febrile convulsion, do not require invasive intracranial EEG monitoring.
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KEYWORD
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Anterior temporal lobectomy, Non-invasive presurgical evaluation, Predictors of outcome
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