Rafael Toledano1,2, Adolfo Jiménez-Huete3, Pablo Campo4, Claudia Poch5, Irene García-Morales1,6, Juan Carlos Gómez Angulo7, Roland Coras8, Ingmar Blümcke8, Juan Álvarez-Linera9, Antonio Gil-Nagel1. 1. Epilepsy Unit, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain. 2. Epilepsy Unit, Department of Neurology, Hospital Ramon y Cajal, Madrid, Spain. 3. Department of Neurology, Hospital Ruber Internacional, Madrid, Spain. 4. Department of Basic Psychology, Autonoma University of Madrid, Madrid, Spain. 5. Department of Biological and Health Psychology, Autonoma University of Madrid, Madrid, Spain. 6. Epilepsy Unit, Department of Neurology, Hospital Clinico San Carlos, Madrid, Spain. 7. Department of Neurosurgery, Hospital Ruber Internacional, Madrid, Spain. 8. Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany. 9. Department of Neuroradiology, Hospital Ruber Internacional, Madrid, Spain.
Abstract
OBJECTIVE: Small temporal pole encephalocele (STPE) can be the pathologic substrate of epilepsy in a subgroup of patients with noninformative magnetic resonance imaging (MRI). Herein, we analyzed the clinical, neurophysiologic, and radiologic features of the epilepsy found in 22 patients with STPE, and the frequency of STPE in patients with refractory focal epilepsy (RFE). METHODS: We performed an observational study of all patients with STPE identified at our epilepsy unit from January 2007 to December 2014. Cases were detected through a systematic search of our database of RFE patients evaluated for surgery, and a prospective collection of patients identified at the outpatient clinic. The RFE database was also employed to analyze the frequency of STPE among the different clinical subgroups. RESULTS: We identified 22 patients with STPE (11 women), including 12 (4.0%) of 303 patients from the RFE database, and 10 from the outpatient clinic. The median age was 51.5 years (range 29-75) and the median age at seizure onset was 38.5 years (range 15-73). Typically, 12 (80%) of 15 patients with left STPE reported seizures with impairment of language. Among the RFE cases, STPE were found in 9.6% of patients with temporal lobe epilepsy (TLE), and in 0.5% of those with extra-TLE (p = 0.0001). STPEs were more frequent in TLE patients with an initial MRI study reported as normal (23.3%) than in those with MRI-visible lesions (1.4%; p = 0.0002). Stereo-electroencephalography was performed in four patients, confirming the localization of the epileptogenic zone at the temporal pole with late participation of the hippocampus. Long-term seizure control was achieved in four of five operated patients. SIGNIFICANCE: STPE can be a hidden cause of TLE in a subgroup of patients with an initial report of "normal" MRI. Early identification of this lesion may help to select patients for presurgical evaluation and tailored resection. Wiley Periodicals, Inc.
OBJECTIVE: Small temporal pole encephalocele (STPE) can be the pathologic substrate of epilepsy in a subgroup of patients with noninformative magnetic resonance imaging (MRI). Herein, we analyzed the clinical, neurophysiologic, and radiologic features of the epilepsy found in 22 patients with STPE, and the frequency of STPE in patients with refractory focal epilepsy (RFE). METHODS: We performed an observational study of all patients with STPE identified at our epilepsy unit from January 2007 to December 2014. Cases were detected through a systematic search of our database of RFE patients evaluated for surgery, and a prospective collection of patients identified at the outpatient clinic. The RFE database was also employed to analyze the frequency of STPE among the different clinical subgroups. RESULTS: We identified 22 patients with STPE (11 women), including 12 (4.0%) of 303 patients from the RFE database, and 10 from the outpatient clinic. The median age was 51.5 years (range 29-75) and the median age at seizure onset was 38.5 years (range 15-73). Typically, 12 (80%) of 15 patients with left STPE reported seizures with impairment of language. Among the RFE cases, STPE were found in 9.6% of patients with temporal lobe epilepsy (TLE), and in 0.5% of those with extra-TLE (p = 0.0001). STPEs were more frequent in TLEpatients with an initial MRI study reported as normal (23.3%) than in those with MRI-visible lesions (1.4%; p = 0.0002). Stereo-electroencephalography was performed in four patients, confirming the localization of the epileptogenic zone at the temporal pole with late participation of the hippocampus. Long-term seizure control was achieved in four of five operated patients. SIGNIFICANCE: STPE can be a hidden cause of TLE in a subgroup of patients with an initial report of "normal" MRI. Early identification of this lesion may help to select patients for presurgical evaluation and tailored resection. Wiley Periodicals, Inc.
Authors: Karen Blackmon; William B Barr; Chris Morrison; William MacAllister; Michelle Kruse; Christina Pressl; Xiuyuan Wang; Patricia Dugan; Anli A Liu; Eric Halgren; Orrin Devinsky; Thomas Thesen Journal: Epilepsy Behav Date: 2019-06-07 Impact factor: 2.937
Authors: Nicolin Hainc; Mary Pat McAndrews; Taufik Valiante; Danielle M Andrade; Richard Wennberg; Timo Krings Journal: Insights Imaging Date: 2022-06-04