Abstract
Chronic seizures as a presenting feature of low grade temporal lobe gliomas and hippocampal sclerosis (HS) are reported to have similar outcomes although the prognostic indicators may not be the same. This study seeks to identify the variables that are associated with poor surgical outcome in both conditions. A retrospective analysis from our epilepsy data base was performed. All low-grade temporal lobe gliomas were selected and relevant variables were compared to the same variables in HS patients. There were 34 tumors (out of 233 cases of chronic temporal lobe epilepsy = 14.6 %) with a mean age of onset of 19 years, and the preoperative duration was 12.3 years. When compared to 120 HS patients both of these factors were significantly different (p < 0.001). Age at the time of surgery for tumors was 31.08 (p = 0.5). Tumors were left sided in 20 patients. In tumor cases amygdala resection was complete in 75 %, for hippocampus 24 % were complete and 39 % partial. Astrocytoma, ganglioglioma and oligodendroglioma constituted 80 % of tumor cases. Good outcome (Engel’s Class I) was achieved in 88.2 % of tumor cases and 71 % of HS cases while poor outcome (Class III + IV) was seen in 5.9 and 16.7 % respectively. The follow up period for the two groups was not significantly different. In multivariate logistic regression analysis, the groups differed significantly in preoperative delay (between diagnosis and surgery) and in epilepsy outcome. Chronic temporal lobe epilepsy due to low-grade tumors had significantly better surgical outcome with considerably less preoperative delay. The age of onset of seizures was younger in HS patients but a delay in surgical treatment was significantly longer. Given that the diagnosis of treatment-resistant TLE secondary to HS can be established after two failed AED trials at optimal doses, shortening the interval between diagnosis and surgery may improve epilepsy outcome.
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Berger MS, Ghatan S, Haglund MM, Dobbins J, Ojemann GA (1993) Low-grade gliomas associated with intractable epilepsy: seizure outcome utilizing electrocorticography during tumor resection. J Neurosurg 79:62–69
Kirkpatrick PJ, Honavar M, Janota I, Polkey CE (1993) Control of temporal lobe epilepsy following en bloc resection of low-grade tumors. J Neurosurg 78:19–25
Khajavi K, Comair YG, Wyllie E, Palmer J, Morris HH, Hahn FJ (1999) Surgical management of pediatric tumor-associated epilepsy. J Child Neurol 14:15–25
Ianelli A, Guzetta F, Battaglia D, Iuvone L, Di Rocco C (2000) Surgical treatment of temporal tumors associated with epilepsy in children. Pediatr Neurosurg 32:248–254
Packer RJ, Sutton LN, Patel KM, Duhaime AC, Schiff S, Weinstein SR et al (1994) Seizure control following tumor surgery for childhood cortical low-grade gliomas. J Neurosurg 80:998–1003
Zentner J, Hufnagel A, Wolf HK, Ostertun B, Behrens E, Campos MG et al (1997) Surgical treatment of neoplasms associated with medically intractable epilepsy. Neurosurgery 41:378–387
Bernasconi A, Bernasconi N, Caramanos Z et al (2000) T2 relaxometry can lateralize mesial temporal lobe epilepsy in patients with normal MRI. Neuroimage 12:739–746
Kuzniecky R, Ho SS, Martin R et al (1999) Temporal lobe developmental malformations and hippocampal sclerosis. Epilepsy surgical outcome. Neurology 52:479–484
Raymond AA, Fish DR, Stevens JM, Cook MJ, Sisodiya SM, Shorvon SD (1994) Association of hippocampal sclerosis with cortical dysgenesis in patients with epilepsy. Neurology 44:1841–1845
Moran NF, Lemieux L, Kitchen ND, Fish DR, Shorvon SD (2001) Extrahippocampal temporal lobe atrophy in temporal lobe epilepsy and mesial temporal sclerosis. Brain 124:167–175
Bernasconi N, Natsume J, Bernasconi A (2005) Progression in temporal lobe epilepsy: differential atrophy in mesial temporal structures. Neurology 65:223–228
Lopez HE, Fohlen M, Lelouch-Tubiana A, Robain O, Jalin C, Belteau C, Dorfmuller G, Dulac O, Delalande O (2010) Heterotopia associated with hippocampal sclerosis: an under-recognized cause of early onset epilepsy in children operated on for temporal lobe epilepsy. Neuropediatrics 41:167–175
Benifla M, Otsubo H, Ochi A et al (2006) Temporal lobe surgery for intractable epilepsy in children: an analysis of outcomes in 126 children. Neurosurgery 59:1203–1213
Mittal S, Montes JL, Farmer JP et al (2005) Long-term outcome after surgical treatment of temporal lobe epilepsy in children. J Neurosurg 103:401–412
Nolan MA, Sakuta R, Chuang N et al (2004) Dysembryoplastic neuroepithelial tumors in childhood: long-term outcome and prognostic features. Neurology 62:2270–2276
Tassi L, Meroni A, Deleo F, Villani F, Mai R, Russo GL, Colombo N, Avanzini G, Falcone C, Bramerio M, Citterio A, Garbelli R, Spreafico R (2009) Temporal lobe epilepsy: neuropathological and clinical correlations in 243 surgically treated patients. Epileptic Disord 11(4):281–292
Blümcke I, Thom M, Wiestler OD (2002) Ammon’s horn sclerosis: a maldevelopmental disorder associated with temporal lobe epilepsy. Brain Pathol 12:199–211
Wolf HK, Campos MG, Zentner J, Hufnagel A, Schramm J, Elger CE, Wiestler O (1993) Surgical pathology of temporal lobe epilepsy. Experience with 216 cases. J Neuropathol Exp Neurol 52:499–506
Britton JW, Cascino GD, Sharbrough FW, Kelly PJ (1994) Low-grade glial neoplasms and intractable partial epilepsy: efficacy of surgical treatment. Epilepsia 35:1130–1135
Fried I, Kim JH, Spencer DD (1994) Limbic and neocortical gliomas associated with intractable seizures: a distinct clinicopathological group. Neurosurgery 34:815–824
Cataltepe O, Turanli G, Yalnizoglu D, Topcu M, Akalan N (2005) Surgical management of temporal lobe tumor-related epilepsy in children. Neurosurg (pediatrics) 102:280–287
Zaatreh MM, Firlik KS, Spencer DD, Spencer SS (2003) Temporal lobe tumoral epilepsy: characteristics and predictors of surgical outcome. Neurology 61:636–641
Phi JH, Kim S, Cho BK, Lee SY, Park SY, Park S, Lee SK, Kim KJ, Chung CK (2009) Long term surgical outcomes of temporal lobe epilepsy associated with low-grade brain tumors. Cancer 115(24):5771–5779
Ruban D, Byrne RW, Kanner AM, Smith M, Cochran EJ, Roh D, Whisler WW (2009) Chronic epilepsy associated with temporal tumors: long term surgical outcome. Neurosurg Focus 27:E6
Morris HH, Estes ML, Gilmore R, Van Ness PC, Barnett GH, Turnbull J (1993) Chronic intractable epilepsy as the only symptom of primary brain tumor. Epilepsia 34:1038–1043
Drake J, Hoffman HJ, Kobayashi J, Hwang P, Becker LE (1987) Surgical management of children with temporal lobe epilepsy and mass lesions. Neurosurgery 21:792–797
Jooma R, Yeh HS, Privitera MD, Gartner M (1995) Lesionectomy versus electrophysiologically guided resection for temporal lobe tumors manifesting with complex partial seizures. J Neurosurg 83:231–236
Mathern GW, Babb TL, Pretorius JK, Melendez M, Lévesque MF (1995) The pathophysiologic relationships between lesion pathology, intracranial ictal EEG onsets, and hippocampal neuron loss in temporal lobe epilepsy. Epilepsy Res 21:133–147
Thom M, Mathern GW, Cross JH, Bertram EH (2010) Mesial temporal lobe epilepsy: how do we improve surgical outcome? Ann Neurol 68:424–434
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Vannemreddy, P.S.S.V., Kanner, A.M., Smith, M.C. et al. Chronic epilepsy due to low grade temporal lobe tumors and due to hippocampal sclerosis: Do they differ in post-surgical outcome?. J Neurooncol 115, 225–231 (2013). https://doi.org/10.1007/s11060-013-1217-0
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DOI: https://doi.org/10.1007/s11060-013-1217-0