Skip to main content
SpringerLink
Log in

Clinical and neurophysiological correlations in patients with refractory partial epilepsy and intracranial structural lesions

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Twenty patients (13 males, 7 females), who presented with refractory partial epilepsy and a CT and/or MR detected intracranial intra-axial structural lesion were admitted to the University of Gent Epilepsy Monitoring Unit. Mean duration of the epilepsy was 17 years (2–47 years). All patients were enrolled in a comprehensive presurgical protocol including neurological examination, videoscalp-EEG monitoring with prolonged interictal and ictal recording, neuropsychological assessment and positron emission tomography (PET). Intracranial EEG monitoring was performed in 5 patients in whom discrepancies between different tests were found during the non-invasive evaluation. Clinical neurological examination was normal in 16 patients; 4 patients had a mild contralateral hemiparesis. Lesions were mainly located in the temporal lobe (55%). Most patients presented with complex partial seizures (90%). Clinical seizure characteristics correlated well with the lesion location in 55% of patients. Interictal EEG showed focal epileptic activity and focal slowing in respectively 85% and 30% of patients. Interictal EEG lateralization was congruent with the side of the lesion in 17 patients (85%). Interictal EEG localization was congruent with the lobe of the lesion in 13 patients (65%). Ictal EEG lateralized correctly in 14 patients (70%) and localized correctly in 10 patients (50%). Neuropsychological assessment lateralized and localized congruently in respectively 8/17 (47%) and 7/17 (41%) of patients. Interictal PET showed focal interictal hypometabolism, congruent with the lesion, in 13/16 (81%) of patients. Intracranial EEG was congruent with the lesion location in 3 patients but non-congruent in 2 patients.

All patients underwent surgical procedures: average follow-up was 14 months (6–24 months). Complete surgical removal of the lesion with free margins resulted in a more than 90% reduction of seizures without postoperative neurological deficit in 12/13 patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Achten R, Boon P, De Poorter J, Vandamme F, Verstraete K, Kumen M (1993) Multiparameter MRI and MRs of the temporal lobe in normal subjects and in patients with complex partial seizures. Proceedings SMRI

  2. Adler J, Erba G, Winston KR, Welch K, Lombroso T (1991) Results of surgery for extratemporal partial epilepsy that began in childhood. Arch Neurol 48: 133–140

    PubMed  Google Scholar 

  3. Awad IA, Rosenfield J, Ahl H, Hahn JF, Lueders H (1991) Intractable epilepsy and structural lesions of the brain: mapping, resection strategies and seizure outcome. Epilepsia 32: 179–186

    PubMed  Google Scholar 

  4. Binnie CD (1993) Electroencephalography. In: Laidlaw J, Richens A, Chadwick D (eds) A textbook of epilepsy, 4th Ed. Churchill Livingstone, Edinburgh, pp 277–348

    Google Scholar 

  5. Blume WT, Girvin JP, Kaufman JC (1982) Childhood brain tumors presenting as chronic, uncontrolled seizure disorders. Ann Neurol 12: 538–541

    PubMed  Google Scholar 

  6. Boon PA, Williamson PD (1989) Presurgical evaluation of patients with intractable partial seizures, indications and evaluation techniques for resective surgery. Clin Neurol Neurosurg 91: 1–11

    Google Scholar 

  7. Boon PA, Williamson PD (1989) The diagnosis of pseudoseizures: a case report and a review of the literature. Clin Neurol Neurosurg 91: 369

    Google Scholar 

  8. Boon PA, Williamson PD, Fried I, Spencer DD, Novelly RA, Spencer SS, Mattson RH (1991) Intracranial, intraaxial, spaceoccupying lesions in patients with intractable partial seizures: an anatomoclinical, neuropsychological and surgical correlation Epilepsia 32: 467–476

    PubMed  Google Scholar 

  9. Boon P, De Reuck J, Thiery E, Decoo D, De Somer A, Achten E, Calliauw L, J Caemaert, Roily G (1993) Matching and mismatching of intracarotid amytal procedure and interictal cerebral positron emission tomography in patients with refractory temporal lobe epilepsy. Epilepsia [Suppl 2]: 25

    Google Scholar 

  10. Boon P, De Reuck J, Drieghe C, De Bruycker K, Aers I, Pengel J (1993) Long-term video-EEG monitoring revisited; the value of interictal and ictal video-EEG recording, a follow-up study. Eur Neurol

  11. Boon P (1993) MRI and focal lesions. Acta Neurol Scand

  12. Cascino GD (1990) Epilepsy and brain tumors: implications for treatment. Epilepsia 31 [Suppl 3]: 37–44

    PubMed  Google Scholar 

  13. Cascino GD, Jack CR, Parisi JE, Sharbrough FW, Hirschorn KA, Meyer NFB, Marsh WR, O'Brien PC (1991) MRI-based volume studies in temporal lobe epilepsy: pathological correlations. Ann Neurol 30: 31–36

    PubMed  Google Scholar 

  14. Cascino GD, Boon PA, Fish D (1993) Lesional syndromes; the effects of intracranial structural lesions in the management of patients with intractable epilepsy. In: Engel J Jr (ed) Surgical treatment of the epilepsies. Raven, New York, pp 77–86

    Google Scholar 

  15. Commission on Classification and Terminology of the International League Against Epilepsy (1989) Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 30: 389–399

    Google Scholar 

  16. Daumas-Duport C, Scheithauser BW, Chodkiewicz JP, Laws ER, Vedrenne C (1988) Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with intractable seizures. Neurosurgery 23: 545–556

    Google Scholar 

  17. Drake J, Hoffman HJ, Kobayasi J, Hwang P, Becker LE (1987) Surgical management of children with temporal lobe epilepsy and mass lesions. Neurosurgery 21: 792–797

    PubMed  Google Scholar 

  18. Dropcho EJ, Wisoff JH, Walker RW, Allen JC (1987) Supratentorial malignant gliomas in childhood: a review of 50 cases. Ann Neurol 22: 355–64

    PubMed  Google Scholar 

  19. Elster A, Mirza W (1990) MRI in chronic partial epilepsy: role of contrast enhancement. AJNR 12: 165–170

    Google Scholar 

  20. Engel J (1987) Outcome with respect to epileptic seizures. In: Surgical treatment of the epilepsies. Raven, New York

    Google Scholar 

  21. Engel J, Kuhl DE, Phelps ME, Maziotta JC (1982) Interictal cerebral glucose metabolism in partial epilepsy and its relation to EEG changes. Ann Neurol 12: 510–517

    PubMed  Google Scholar 

  22. Falconer M, Cavanagh J (1916) Clinicopathological considerations of temporal lobe epilepsy due to small focal lesions. Brain 59 (LXXXVII): 483–504

    Google Scholar 

  23. Fish D, Anderman F, Olivier A (1989) Anterotemporal corticectomy in patients with complex partial seizures and small, relatively inacessible posterotemporal or extratemporal structural lesions. Epilepsia 30: 704

    Google Scholar 

  24. Fish D (1993) MRI and focal lesions. Acta Neurol Scand [Suppl]

  25. Fried I, Jung K, Spencer D (1992) Hippocampal pathology in patients with intractable seizures and temporal lobe masses. J Neurosurg 76: 735–740

    PubMed  Google Scholar 

  26. Frie I, Cascino GD (1993) Lesional surgery. In: Engel J (ed) Surgical treatment of the epilepsies, 2nd Ed. Raven, New York, pp 501–509

    Google Scholar 

  27. Goldring S, Rich KM, Picker S (1986) Experience with lesions that mimic gliomas in patients presenting with a chronic seizure disorder. Clin Neurosurg 33: 15–42

    PubMed  Google Scholar 

  28. Goldring S, Gregorie EM (1986) Experience with lesions that mimic gliomas in patients presenting with a chronic seizure disorder. Clin Neurosurg 33: 43–70

    PubMed  Google Scholar 

  29. Hardjasudarma M (1991) Cavernous and venous angiomas of the CNS neuroimaging. J Neuroimaging 1: 191–196

    Google Scholar 

  30. Henry TR, Engel J, Sutherling WW, Risinger MW, Phelps ME (1987) Correlation of structural and functional imaging with electrographic localization and histopathology in refractory complex partial epilepsy. Epilepsia 28: 601–611

    Google Scholar 

  31. Henry TR, Chugani HT, Abou-Khalil BW, Theodore WH, Swartz BE (1993) Positron emission tomography. In: Engel J (ed) Surgical treatment of the epilepsies, 2nd Ed. Raven, New York, pp 211–323

    Google Scholar 

  32. Hess RM (1987) Conventional electroencephalography. In: Wieser H, Elger CE (eds) Presurgical evaluation of epileptics. Springer, Berlin Heidelberg New York Tokyo, pp 154–161

    Google Scholar 

  33. Hirsch JF (1989) Epilepsie et tumeurs cérébrales chez l'enfant. J Neuroradiol 16: 292–300

    PubMed  Google Scholar 

  34. Hoshino T (1984) A commentary on the biology and growth kinetics of low-grade and high-grade gliomas. J Neurosurg 61: 895–900

    PubMed  Google Scholar 

  35. Jackson JH (1931) Case of a tumor of the right temporosphenoidal lobe, bearing on the localisation of the sense of smell and on the interpretation of a particular variety of epilepsy. In: James Taylor (ed) Selected writings of John Hughlings Jackson, Vol 1. Hodder and Stoughton, London, pp 406–411

    Google Scholar 

  36. Jeannerod M, Hecaen H (1979) Adaptation et restauration des fonctions nerveuses. Simep, Velleurbanne, pp 123–214

    Google Scholar 

  37. Jones-Gotman M, Smith ML, Zatorre RJ (1993) Neuropsychological testing for localizing and lateralizing the epileptogenic region. In: Engel J (ed) Surgical treatment of the epilepsies, 2nd Ed. Raven, New York, pp 245–261

    Google Scholar 

  38. Kiloh LG, Mc Comas AG, Osselton JW, Upton AR: Clinical electroencephalography, 4th Ed. Butterworths, London, pp 133–136

  39. Kunzniecky RI, Casino GD, Palmini A, Jack CR, Berkovic SF, Jackson GD, McCarthy GM (1993) Structural imaging. In: Engel J (ed) Surgical treatment of the epilepsies, 2nd Ed. Raven, New York, pp 197–209

    Google Scholar 

  40. Laws ER, Taylor WF, Clifton MB, Okazaki M (1984) Neurosurgical management of low grade astrocytoma of the cerebral hemisphere. J Neurosurg 61: 665–673

    PubMed  Google Scholar 

  41. Lévesque MF, Nobukazu N, Vinters HV, Babb TL (1991) Surgical treatment of limbic epilepsy associated with extrahippocampal lesions: the problem of dual pathology. J Neurosurg 75: 364–370

    PubMed  Google Scholar 

  42. Mattson RH (1980) Value of intensive monitoring. In: Wada J, Penry JK (eds) Advances in epileptology, 10th epilepsy international symposium. Raven, New York, pp 43–51

    Google Scholar 

  43. Millner B (1975) Psychological aspects of focal epilepsy and its neurosurgical management. In: Purpura DP, Penry JK, Walter RD (eds) Neurosurgical management of the epilepsies: advances in neurology, Vol 8. Raven, New York, pp 299–321

    Google Scholar 

  44. Montplaisir J, Laverdière M, Saint-Hilaire JM, Rouleau I (1987) Sleep and focal epilepsy: a study of patients implanted with depth electrodes. In: Wolf P, Dam M, Janz D, Dreifuss FE (eds) Advances in epileptology. Raven, New York, pp 705–707

    Google Scholar 

  45. Morris HH, Luders H, Hahn JF, Lesser RP, Dinner DS, Estes ML (1986) Neurophysiological techniques as an aid to surgical treatment of primary brain tumors. Ann Neurol 19: 559–67

    PubMed  Google Scholar 

  46. Rasmussen T (1975) Surgery of epilepsy associated with brain tumors. In: Purpura DP, Penry JK, Walter RD (eds) Advances in neurology: neurosurgical management of the epilepsies, Vol 8. Raven, New York, pp 227–239

    Google Scholar 

  47. Rasmussen T (1982) Localization aspects of epileptic seizure phenomena. In: Thompson RA, Green JR (eds) New perspectives in cerebral localization. Raven, New York, pp 177–203

    Google Scholar 

  48. Sammaritano M, de Lotbiniere A, Andermann F, Olivier A, Gloor P, Quesney LF (1987) False localization by surface EEG of seizure onset in patients with temporal lobe epilepsy and gross focal cerebral lesions. Ann Neurol 21(4): 361–9

    PubMed  Google Scholar 

  49. Sammaritano M, Gigli GL, Gotman J (1991) Interictal spiking during wakefulness and sleep and localization of foci in temporal lobe epilepsy. Neurology 41: 290–297

    PubMed  Google Scholar 

  50. Spencer DD, Spencer SS, Mattson RH, Williamson PD (1984) Intracerebral masses in patients with intractable partial epilepsy. Neurology 34: 432–6

    PubMed  Google Scholar 

  51. Spencer SS (1991) Intracranial recording. In: Spencer DD, Spencer SS (eds) Epilepsy surgery. Blackwell, Cambridge, pp 54–64

    Google Scholar 

  52. Swartz BE, Tomiyasu U, Delgado-Escueta AV, Mandelkern M, Khonsari A (1992) Neuroimaging in temporal lobe epilepsy: test sensitivity and relationships to pathology and postsurgical outcome. Epilepsia 33: 624–634

    PubMed  Google Scholar 

  53. Taylor LB (1969) Localization of cerebral lesions by psychological testing. Clin Neurosurg 16: 269–87

    PubMed  Google Scholar 

  54. Van Der Drift JH (1957) The significance of electroencephalography for the diagnosis and localization of brain tumors. Stenfert and Kroese, Leiden

    Google Scholar 

  55. Williamson PD (1986) Intensive monitoring of complex partial seizures: diagnosis and subclassification. In: Gumnit RJ (ed) Advances in neurology, Vol 46. Intensive neurodiagnostic monitoring. Raven, New York, pp 69–89

    Google Scholar 

  56. Williamson PD, Boon PA, Spencer DD, Spencer SS, Mattson RH (1988) Occipital and parietal epilepsy. Epilepsia 29: 682 (abstract)

    Google Scholar 

  57. Williamson PD, Boon PA, Thadani VM, Darcey TM, Spencer DD, Spencer SS, Novelly RA, Mattson RH (1992) Parietal lobe epilepsy: diagnostic considerations and results of surgery. Ann Neurol 31: 193–201

    PubMed  Google Scholar 

  58. Wyler AR, Ojeman GA, Lettich E, Ward AA (1984) Subdural strip electrodes for localizing epileptogenic foci. J Neurosurg 60: 1195–1200

    PubMed  Google Scholar 

  59. Yeh H, Kashiwagi S, Tew JM, Berger TS (1990) Surgical management of epilepsy associated with cerebral arterio venous malformations. J Neurosurg 72: 216–223

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, University Hospital, Gent, Belgium

    P. Boon, J. De Reuck, I. Hoksbergen & D. Decoo

  2. Department of Neurosurgery, University Hospital, Gent, Belgium

    L. Calliauw & J. Caemaert

  3. Department of Radiology, University Hospital, Gent, Belgium

    E. Achten

  4. Department of Medical Psychology (Neuropsychology), University Hospital, Gent, Belgium

    E. Thiery & A. De Somer

Authors
  1. P. Boon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Calliauw
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. De Reuck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. Hoksbergen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Achten
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Thiery
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Caemaert
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. De Somer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D. Decoo
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boon, P., Calliauw, L., De Reuck, J. et al. Clinical and neurophysiological correlations in patients with refractory partial epilepsy and intracranial structural lesions. Acta neurochir 128, 68–83 (1994). https://doi.org/10.1007/BF01400655

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01400655

Keywords

Search

Navigation