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. 2019:65:275-278.
doi: 10.1016/j.ijscr.2019.10.063. Epub 2019 Nov 4.

Mesial temporal lobe epilepsy: A West Indian Neurosurgical Experience

Avidesh Panday  1 , Chrystal Calderon  2 , Sherry Sandy  3 , Devindra Ramnarine  4
Affiliations

Mesial temporal lobe epilepsy: A West Indian Neurosurgical Experience

Avidesh Panday et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: We sought to highlight a case of refractory mesial temporal lobe epilepsy managed via an anterior temporal lobectomy. To our knowledge, this is the first of its kind to be performed and published in the English-speaking Caribbean.

Presentation of case: A 44-year-old female, known seizure disorder for 25 years was referred to the outpatient clinic. Several trials of varying anti-epileptic drugs failed to provide remittance of her frequent partial seizures over the last two decades. Magnetic resonance imaging displayed asymmetry of the hippocampus, with a prominent right temporal horn of lateral ventricle, in keeping with right anteromesial temporal lobe sclerosis. She underwent a right anterior temporal lobectomy after exhaustive counselling; with the guidance of a multidisciplinary team. The post-operative period was uneventful and currently, the patient has been seizure-free since operation.

Discussion: Drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used anti-epileptic drug schedules to attain sustained seizure freedom. Medical management of mesial temporal lobe epilepsy has a relatively poor long-term outcome, with 30 % of patients falling into the category of pharmaco-resistant.

Conclusion: Surgical management of these cases have been proven to be a safe and effective alternative but is currently greatly underutilized. In our literature review, we present the first published case of epilepsy surgery in the English-speaking Caribbean for temporal lobe epilepsy.

Keywords: Anterior temporal lobectomy; Caribbean; Case report; Medical refractory epilepsy; Mesial temporal lobe epilepsy.

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Figures

Fig. A1
Fig. A1
MRI Brain (coronal views) showing asymmetry of the lateral ventricles, with a prominent right temporal horn of the lateral ventricle, indicative of decreased volume in the right hippocampal region.
Fig. A2
Fig. A2
Intra-operative pictures showing the extent of neocortical dissection A. before neocortical resection and B. after neocortical resection with exposure medial temporal lobe structures.
Fig. A3
Fig. A3
MRI Brain T2 weighted (coronal view) demonstrating post-surgical changes following right anterior temporal lobectomy.
See this image and copyright information in PMC

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