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Ergebnisse von Nachoperationen bei 12 Patienten mit Temporallappenepilepsie bei mesialer temporaler Sklerose

Analysis of reoperation of 12 patients with temporal lobe epilepsy and mesial temporal lobe sclerosis

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Abstract

Incomplete resection of mesial temporal lobe structures entails reoperation in a small number of patients with mesial temporal sclerosis (MTS) who had no satisfactory outcome after initial surgery for temporal lobe epilepsy (TLE). We analyzed 12 consecutive patients with MTS (follow-up 14 to 71 months, mean 42.4) by evaluating noninvasive EEG/video monitoring before the first and second surgery (interictal epileptiform discharges—IED, ictal EEG, semiology) and MRI (resection index after the first and second surgery of amygdala, hippocampus, lateral temporal lobe). Five of 12 patients became seizure free. Recurrence of seizures could be predicted by: 1) ictal EEG with propagation to the contralateral temporal lobe (0 of 5 patients seizure free versus 5 of 7 patients; p=0.028); 2) quantity of lateral temporal lobe resection in the second surgery (1.06±0.59 cm versus 2.18±1.37 cm; p=0.037). No significant correlation was found for lateralization of IED, change of semiology, other resection indices, begin and duration of epilepsy, duration of follow-up, and side of surgery. Patients have a less favorable outcome if they show ictal scalp EEG with contralateral propagation and if they had already undergone an extended first resection of the lateral temporal lobe.

Zusammenfassung

Wegen eines unbefriedigenden postoperativen Anfallergebnisses kommt es bei einer kleinen Zahl von Patienten mit Temporallappenepilepsie (TLE) und mesialer temporaler Sklerose (MTS) zu einer Nachresektion. Unsere Untersuchung umfasste 12 aufeinander folgende Patienten mit MTS (Nachbeobachtung 14 bis 71 Monate postoperativ, im Durchschnitt 42,4 Monate); wir analysierten nichtinvasives Video-EEG-Monitoring vor der ersten und vor der zweiten Operation (interiktale epilepsietypische Potenziale—ETP, iktales EEG, Semiologie) und MRI nach der ersten und der zweiten Operation (Resektionsindex von Mandelkern, Hippokampus und lateralem Temporallappen). Fünf von 12 Patienten wurden anfallsfrei. Das Wiederauftreten von Anfällen war korreliert mit: 1) im iktalen EEG Ausprägung eines unabhängigen Musters über dem kontralateralen Temporallappen (0 von 5 Patienten anfallsfrei versus 5 von 7 Patienten; p=0,028); 2) der Ausdehnung der lateralen Temporallappenresektion bei der Nachresektion (1,06±0,59 cm versus 2,18 ±1,37 cm; p=0,037). Keine signifikante Korrelation fanden wir für die Lateralisation der interiktalen ETP, Wechsel der Anfallssemiologie, andere Resektionsindices, Beginn und Dauer der Epilepsie, Dauer der Nachbeobachtung und Seite der Resektion. Patienten müssen demnach bei einer Zweitoperation mit einem weniger günstigen Ergebnis rechnen, wenn sie im iktalenEEG eineAusbreitung des Anfallmusters zur Gegenseite haben oder wenn schon die erste Temporallappenresektion eine große laterale Ausdehnung hat.

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Authors and Affiliations

  1. Epilepsiezentrum Bethel, Maraweg 21, 33617, Bielefeld, Germany

    Reinhard Schulz, Matthias Hoppe, Doerthe Heinemann, Heinz W. Pannek & Alois Ebner

  2. Gesellschaft für Epilepsieforschung, Maraweg 21, 33617, Bielefeld, Germany

    Theodor May

  3. Universitätsklinik Münster, Münster

    Frank Boesebeck

Authors
  1. Reinhard Schulz
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  2. Matthias Hoppe
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  3. Frank Boesebeck
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  4. Doerthe Heinemann
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  5. Heinz W. Pannek
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  6. Theodor May
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  7. Alois Ebner
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Correspondence to Reinhard Schulz.

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Schulz, R., Hoppe, M., Boesebeck, F. et al. Ergebnisse von Nachoperationen bei 12 Patienten mit Temporallappenepilepsie bei mesialer temporaler Sklerose. Z. Epileptol. 19, 11–20 (2006). https://doi.org/10.1007/s10309-006-0160-x

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  • DOI: https://doi.org/10.1007/s10309-006-0160-x

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