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Comparative Study
. 2009 Sep;50(9):2053-60.
doi: 10.1111/j.1528-1167.2009.02079.x. Epub 2009 Apr 6.

Epilepsy surgery outcomes in temporal lobe epilepsy with a normal MRI

Michael L Bell  1 , Satish Rao, Elson L So, Max Trenerry, Noojan Kazemi, S Matt Stead, Gregory Cascino, Richard Marsh, Fredric B Meyer, Robert E Watson, Caterina Giannini, Gregory A Worrell
Affiliations
Comparative Study

Epilepsy surgery outcomes in temporal lobe epilepsy with a normal MRI

Michael L Bell et al. Epilepsia. 2009 Sep.

Abstract

Purpose: To determine the long-term efficacy of anterior temporal lobectomy for medically refractory temporal lobe epilepsy in patients with nonlesional magnetic resonance imaging (MRI).

Methods: We identified a retrospective cohort of 44 patients with a nonlesional modern "seizure protocol" MRI who underwent anterior temporal lobectomy for treatment of medically refractory partial epilepsy. Postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Noninvasive preoperative diagnostic factors potentially associated with excellent surgical outcome were examined by univariate analysis in the 40 patients with follow-up of >1 year.

Results: Engel class I outcomes (free of disabling seizures) were observed in 60% (24 of 40) patients. Preoperative factors associated with Engel class I outcome were: (1) absence of contralateral or extratemporal interictal epileptiform discharges, (2) subtraction ictal single photon emission computed tomography (SPECT) Coregistered to MRI (SISCOM) abnormality localized to the resection site, and (3) subtle nonspecific MRI findings in the mesial temporal lobe concordant to the resection.

Discussion: In carefully selected patients with temporal lobe epilepsy and a nonlesional MRI, anterior temporal lobectomy can often render patients free of disabling seizures. This favorable rate of surgical success is likely due to the detection of concordant abnormalities that indicate unilateral temporal lobe epilepsy in patients with nonlesional MRI.

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Conflict of interest statement

Disclosure: The authors have nothing to disclose.

Figures

Figure 1
Figure 1
Kaplan–Meyer curve of Engel class I survival. Epilepsia © ILAE
Figure 2
Figure 2
Examples of subtle abnormalities appreciated on MRI re-review. Upper panel shows FLAIR (left) and T1-SPGR (right) images of subtle left hippocampal signal abnormality without atrophy. Lower panel shows FLAIR (left) and T1-SPGR (right) images of subtle left hippocampal atrophy without signal abnormality. Epilepsia © ILAE
See this image and copyright information in PMC

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