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Neurosurgical Review

, Volume 4, Issue 2, pp 61–69 | Cite as

Late results of operation in temporal lobe epilepsy in adults and children

  • L. Stępień
  • T. Bacia
  • J. Bidziński
  • J. Wisławski
Originals

Summary

In our clinic at the Medical Academy in Warsaw 282 patients with temporal lobe epilepsy were treated surgically. The causes of the illness were trauma in 43.2%, including birth trauma in 19.5%, infections diseases in early life in 19.8%, and microtumours in 6.8%. In 30% the aetiology was unknown. Fifty per cent had fits before 10 years and 75% before 20 years of age. The period of conservative treatment was on average nine years. Serial and stereo-EEG recordings including activation by ketamine, as well as intracarotid sodium amytal tests were performed routinely. The interictal EEG epileptiform abnormalities were found most frequently in both temporal lobes (154 cases).

The operation was carried out according to Penfield's technique, with electrocorticography and resection of the temporal lobe extending for 6 to 10 cm in the nondominant hemisphere and for 4 to 5 cm in the dominant hemisphere using suction technique. In 75% microscopical changes in the hippocampus were found, in 20% so-called hamartomas and in 6.8% small gliomas.

Two patients died and in 13 patients there was a hemiparesis which was transient in 10.

The authors present the analysis of late results of 262 cases with a follow-up from 2 to 22 years after operation.

Very good results were obtained in 127 cases (48.5%) — no attacks since leaving the clinic. Good results were observed in 42 patients (16%) — not more than 1–2 attacks a year. Thus, the operation resulted in freedom from attacks, or nearly so, in 169 cases (64.5%). In an additional 47 patients (18%) there was a significant reduction (at least 50%) in seizures without complete freedom from attacks, and in 44 cases (16.8%) no improvement was observed.

The analysis of our series suggests that the best results may be obtained in patients with unilateral temporal EEG changes. The existence of an additional focus in parts of the other temporal lobe does not impair the operative results when the dominant epileptic focus has been removed.

Among 24 cases with equally pronounced bitemporal EEG abnormalities the stereo-EEG studies allowed detection of the epileptic focus in 13 patients (54%).

Detailed analysis of the results, obtained in 51 children below 15 years of age, led to the conclusion that temporal lobe epilepsy should be operated upon even in young children, provided that the epileptic focus can be clearly identified.

Key words

Temporal lobe epilepsy EEG and stereo-EEG examination Temporal lobectomy Pathological substrates Surgery in children Bilateral temporal EEG abnormalities Mental retardation 

Zusammenfassung

In der Neurochirurgischen Klinik der Medizinischen Akademie Warschau wurden 282 Kranke mit Temporallappenepilepsie operativ behandelt. Ätiologisch fanden sich: Traumen in 43,2%, darunter Geburtstraumen in 19,5%, Infektionen in den ersten Lebensjahren in 19,8% und Mikrotumoren in 6,8%. Ungeklärt blieben 30%; 50% hatten Anfälle vor dem 10. Lebensjahr und 76% vor dem 20. Eine antiepileptische Therapie wurde im Durchschnitt über 9 Jahre durchgeführt. Serien-, Aktivierungs- (jetzt mit Ketamin) und Stereo-EEG-Ableitungen, sowie intracarotideale Amythal-Tests wurden routinemäßig durchgeführt. Interiktale epileptiforme Abnormalitäten fanden sich am häufigsten (in 154 Fällen) bilateral.

Das operative Vorgehen erfolgte nach Penfield's Technik mit Elektrokortikographie und nachfolgender Resektion des Temporallappens, in der nicht dominanten Hemisphäre in einer Ausdehnung von 6 bis 10 cm und in der dominanten von 4 bis 5 cm, mit der Saugtechnik. In 75% fanden sich mikroskopische Veränderungen im Hippocampus, in 20% sogenannte Hamartome und in 6,8% Mikro-Gliome.

2 Kranke verstarben, 13 hatten Hemiparesen, davon 3 in permanenter Form.

Die Autoren legen die Spätergebnisse von 262 Fällen nach 2 bis 22 Jahren vor. 127 Kranke (48,5%) hatten ein sehr gutes Ergebnis und 42 (16%) ein gutes Ergebnis mit 1 bis 2 Anfällen jährlich, d. h. 169 Kranke oder 64,5% waren anfallsfrei oder nahezu anfallsfrei. Weitere 47 Patienten (18%) gaben eine wesentliche Anfallsreduzierung von mindestens 50% an. 44 Fälle, d. h. 16,8% blieben unbeeinflußt. Das Ergebnis war am besten bei unilateralem EEG-Focus. Die Existenz eines zusätzlichen Focus in anderen Teilen des Temporallappens beeinflußte das Operationsergebnis nicht, wenn der dominante Krampfherd entfernt wurde. Unter 24 Fällen mit gleichmäßig ausgeprägten bitemporalen Krampfherden erlaubten Stereo-EEG-Untersuchungen den führenden Krampfherd bei 13 Kranken (54%) aufzudecken. Eine eingehende Analyse des Spätergebnisses bei 51 Kindern unter 15 Jahren führte zu der Erkenntnis, daß auch bei jüngeren Kindern der Eingriff durchgeführt werden kann, wenn der EEG-Krampfherd eindeutig lokalisiert ist.

Schlüsselwörter

Temporallappen-Epilepsie EEG und Stereo-EEG-Untersuchung Temporale Lobektomie Pathologische Befunde Operative Behandlung bei Kindern Bilaterale Krampfherde Psychische Retardierung 

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Copyright information

© Walter de Gruyter & Co 1981

Authors and Affiliations

  • L. Stępień
    • 1
    • 2
  • T. Bacia
    • 1
  • J. Bidziński
    • 1
  • J. Wisławski
    • 1
  1. 1.Neurosurgical ClinicMedical AcademyWarsawPoland
  2. 2.Klinika Neurochirurgii A.M.WarszawaPoland

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