PURPOSE: To perform a quantitative MRI and retrospective electrophysiological study to investigate whether persistent post-surgical seizures may be due to brain structural and functional abnormalities in temporal lobe cortex beyond the margins of resection and/or bilateral abnormalities in patients with temporal lobe epilepsy (TLE). METHODS: In 22 patients with left TLE and histopathological evidence of hippocampal sclerosis, we compared pre-surgical brain morphology between patients surgically remedied (Engel's I) and patients with persistent post-surgical seizures (PPS, Engel's II-IV) using voxel-based morphometry (VBM). Routine pre-surgical EEG and invasive and non-invasive telemetry investigations were additionally compared between patient groups. RESULTS: Results indicated widespread structural and functional abnormalities in patients with PPS relative to surgically remedied patients. In particular, patients with PPS had significantly reduced volume of the ipsilateral posterior medial temporal lobe and contralateral medial temporal lobe relative to surgically remedied patients. Furthermore, successful surgery was associated with clear anterior (89%) and unilateral (100%) temporal lobe EEG abnormalities, whilst PPS were associated with widespread ipsilateral (91%) and bilateral (82%) temporal lobe abnormalities. DISCUSSION: We suggest that these preliminary data support the hypothesis that PPS after temporal lobe surgery are due to functionally connected epileptogenic cortex remaining in the ipsilateral posterior temporal lobe and/or in temporal lobe contralateral to resection.
PURPOSE: To perform a quantitative MRI and retrospective electrophysiological study to investigate whether persistent post-surgical seizures may be due to brain structural and functional abnormalities in temporal lobe cortex beyond the margins of resection and/or bilateral abnormalities in patients with temporal lobe epilepsy (TLE). METHODS: In 22 patients with left TLE and histopathological evidence of hippocampal sclerosis, we compared pre-surgical brain morphology between patients surgically remedied (Engel's I) and patients with persistent post-surgical seizures (PPS, Engel's II-IV) using voxel-based morphometry (VBM). Routine pre-surgical EEG and invasive and non-invasive telemetry investigations were additionally compared between patient groups. RESULTS: Results indicated widespread structural and functional abnormalities in patients with PPS relative to surgically remedied patients. In particular, patients with PPS had significantly reduced volume of the ipsilateral posterior medial temporal lobe and contralateral medial temporal lobe relative to surgically remedied patients. Furthermore, successful surgery was associated with clear anterior (89%) and unilateral (100%) temporal lobe EEG abnormalities, whilst PPS were associated with widespread ipsilateral (91%) and bilateral (82%) temporal lobe abnormalities. DISCUSSION: We suggest that these preliminary data support the hypothesis that PPS after temporal lobe surgery are due to functionally connected epileptogenic cortex remaining in the ipsilateral posterior temporal lobe and/or in temporal lobe contralateral to resection.
Authors: Helen E Scharfman; Andres M Kanner; Alon Friedman; Ingmar Blümcke; Candice E Crocker; Fernando Cendes; Ramon Diaz-Arrastia; Hans Förstl; André A Fenton; Anthony A Grace; Jorge Palop; Jason Morrison; Astrid Nehlig; Asuri Prasad; Karen S Wilcox; Nathalie Jette; Bernd Pohlmann-Eden Journal: Epilepsy Behav Date: 2017-10-31 Impact factor: 2.937
Authors: Brent C Munsell; Chong-Yaw Wee; Simon S Keller; Bernd Weber; Christian Elger; Laura Angelica Tomaz da Silva; Travis Nesland; Martin Styner; Dinggang Shen; Leonardo Bonilha Journal: Neuroimage Date: 2015-06-06 Impact factor: 6.556
Authors: Alexander C Whiting; Marcia Morita-Sherman; Manshi Li; Deborah Vegh; Brunno Machado de Campos; Fernando Cendes; Xiaofeng Wang; William Bingaman; Lara E Jehi Journal: Epilepsia Date: 2021-03-23 Impact factor: 5.864