Mette Thrane Foged1, Kirsten Vinter2, Louise Stauning3, Troels W Kjær4, Brice Ozenne5, Sándor Beniczky6, Olaf B Paulson1, Flemming Find Madsen7, Lars H Pinborg8. 1. Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 28 Juliane Maries Vej, 3rd Floor, Building 6931, DK-2100 Copenhagen, Denmark. 2. Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 8 Ester Møllers Vej, 1.th Floor, Entrance 85, DK-2100 Copenhagen, Denmark. 3. Department of Neuropsychology, Danish Epilepsy Centre, 1 Kolonivej, DK-4293 Dianalund, Denmark. 4. Centre of Neurophysiology, Zealand University Hospital, 11 Vestermarksvej, Ground Floor, DK-4000 Roskilde, Denmark. 5. Department of Public Health, Section of Biostatistics, University of Copenhagen, 5 Øster Farimagsgade, DK-1014 Copenhagen, Denmark. 6. Department of Clinical Neurophysiology, Danish Epilepsy Centre, 1 Kolonivej, DK-4293 Dianalund, Denmark; Department of Clinical Neurophysiology, Aarhus University, 44 Nørrebrogade, Ground Floor, Entrance 10, DK-8000 Aarhus C, Denmark. 7. Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, 7 Inge Lehmanns Vej, 9.th Floor, Entrance 2, DK-2100 Copenhagen, Denmark. 8. Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 28 Juliane Maries Vej, 3rd Floor, Building 6931, DK-2100 Copenhagen, Denmark; Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 8 Ester Møllers Vej, 1.th Floor, Entrance 85, DK-2100 Copenhagen, Denmark. Electronic address: lars.pinborg@nru.dk.
Abstract
PURPOSE: With the advent of new very selective techniques like thermal laser ablation to treat drug-resistant focal epilepsy, the controversy of resection size in relation to seizure outcome versus cognitive deficits has gained new relevance. The purpose of this study was to test the influence of the selective amygdalohippocampectomy (SAH) versus nonselective temporal lobe resection (TLR) on seizure outcome and cognition in patients with mesial temporal lobe epilepsy (MTLE) and histopathological verified hippocampal sclerosis (HS). METHODS: We identified 108 adults (>16years) with HS, operated between 1995 and 2009 in Denmark. Exclusion criteria are the following: Intelligence below normal range, right hemisphere dominance, other native languages than Danish, dual pathology, and missing follow-up data. Thus, 56 patients were analyzed. The patients were allocated to SAH (n=22) or TLR (n=34) based on intraoperative electrocorticography. Verbal learning and verbal memory were tested pre- and postsurgery. RESULTS: Seizure outcome did not differ between patients operated using the SAH versus the TLR at 1year (p=0.951) nor at 7years (p=0.177). Verbal learning was more affected in patients resected in the left hemisphere than in the right (p=0.002). In patients with left-sided TLR, a worsening in verbal memory performance was found (p=0.011). Altogether, 73% were seizure-free for 1year and 64% for 7years after surgery. CONCLUSION: In patients with drug-resistant focal MTLE, HS and no magnetic resonance imaging (MRI) signs of dual pathology, selective amygdalohippocampectomy results in sustained seizure freedom and better memory function compared with patients operated with nonselective temporal lobe resection.
PURPOSE: With the advent of new very selective techniques like thermal laser ablation to treat drug-resistant focal epilepsy, the controversy of resection size in relation to seizure outcome versus cognitive deficits has gained new relevance. The purpose of this study was to test the influence of the selective amygdalohippocampectomy (SAH) versus nonselective temporal lobe resection (TLR) on seizure outcome and cognition in patients with mesial temporal lobe epilepsy (MTLE) and histopathological verified hippocampal sclerosis (HS). METHODS: We identified 108 adults (>16years) with HS, operated between 1995 and 2009 in Denmark. Exclusion criteria are the following: Intelligence below normal range, right hemisphere dominance, other native languages than Danish, dual pathology, and missing follow-up data. Thus, 56 patients were analyzed. The patients were allocated to SAH (n=22) or TLR (n=34) based on intraoperative electrocorticography. Verbal learning and verbal memory were tested pre- and postsurgery. RESULTS:Seizure outcome did not differ between patients operated using the SAH versus the TLR at 1year (p=0.951) nor at 7years (p=0.177). Verbal learning was more affected in patients resected in the left hemisphere than in the right (p=0.002). In patients with left-sided TLR, a worsening in verbal memory performance was found (p=0.011). Altogether, 73% were seizure-free for 1year and 64% for 7years after surgery. CONCLUSION: In patients with drug-resistant focal MTLE, HS and no magnetic resonance imaging (MRI) signs of dual pathology, selective amygdalohippocampectomy results in sustained seizure freedom and better memory function compared with patients operated with nonselective temporal lobe resection.
Authors: Kajol Marathe; Ali Alim-Marvasti; Karan Dahele; Fenglai Xiao; Sarah Buck; Aidan G O'Keeffe; John S Duncan; Vejay N Vakharia Journal: Front Neurol Date: 2021-12-09 Impact factor: 4.003