"MRI-negative PET-positive" temporal lobe epilepsy: invasive EEG findings, histopathology, and postoperative outcomes.
ABSTRACT The aim of this retrospective study was to analyze invasive EEG findings, histopathology, and postoperative outcomes in patients with MRI-negative, PET-positive temporal lobe epilepsy (TLE) (MRI-/PET+TLE) who had undergone epilepsy surgery. We identified 20 patients with MRI-/PET+TLE (8.4% of all patients with TLE who had undergone surgery; 11 men, 9 women). Of the 20 patients, 16 underwent invasive EEG. The temporal pole and hippocampus were involved in the seizure onset zone in 62.5% of the patients. We did not identify a lateral temporal or extratemporal seizure onset in any patient. Of the 20 patients, 17 had follow-up periods >1 year (mean follow-up=3.3 years). At the final follow-up, 70.6% patients were classified as Engel I, 5.8% of patients as Engel II, and 11.8% of patients as Engel III and IV (11.8%). Histopathological evaluation showed no structural pathology in any resected hippocampus in 58% of all evaluated temporal poles. The most common pathology of the temporal pole was focal cortical dysplasia type IA or IB. MRI-/PET+TLE should be delineated from other "nonlesional TLE." The ictal onset in these patients was in each case in the temporal pole or hippocampus, rather than in the lateral temporal neocortex. Standard surgery produced a good postoperative outcome, comparable to that for patients with lesional TLE. Histopathological findings were limited: the most common pathology was focal cortical dysplasia type I.
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Article: Neocortical temporal lobe epilepsy.[Show abstract] [Hide abstract]
ABSTRACT: Complex partial seizures (CPSs) can present with various semiologies, while mesial temporal lobe epilepsy (mTLE) is a well-recognized cause of CPS, neocortical temporal lobe epilepsy (nTLE) albeit being less common is increasingly recognized as separate disease entity. Differentiating the two remains a challenge for epileptologists as many symptoms overlap due to reciprocal connections between the neocortical and the mesial temporal regions. Various studies have attempted to correctly localize the seizure focus in nTLE as patients with this disorder may benefit from surgery. While earlier work predicted poor outcomes in this population, recent work challenges those ideas yielding good outcomes in part due to better localization using improved anatomical and functional techniques. This paper provides a comprehensive review of the diagnostic workup, particularly the application of recent advances in electroencephalography and functional brain imaging, in neocortical temporal lobe epilepsy.Epilepsy research and treatment. 01/2012; 2012:103160.
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ABSTRACT: Primary- and secondary MR findings, volumetric measurements and MR spectroscopy data of each hippocampus represent more a dozen of variables that radiologists should consider in a quantitative MR report of temporal lobe epilepsy (TLE). There is a paucity of data about the significance of secondary MR findings simultaneously evaluated with volumetry and MR spectroscopy. We analyzed the influence of qualitative-secondary MR findings simultaneously with quantitative (volumetry and spectroscopy) data in MRI positive- and negative patients with mesial temporal sclerosis (MTS). Analytic and transversal study of 59 patients with TLE and suspiciousness of MTS. 13 variables were analyzed for each hippocampus: age, gender, cerebral hemisphere, temporal lobe atrophy, choroidal fissure dilatation, mamillary body atrophy, collateral white matter atrophy, fornix asymmetry; Naa/Cr, Cho/Cr, mI/Cr, Naa/(Cr+Cho); and hippocampus volume (mm3). Multivariate discriminant analysis (DA) was performed with the aim to identify specific morphologic and metabolic attributes in hippocampi with and without MTS. Discriminant function significantly differentiated the hippocampi with- and without MTS (Wilks' λ = 0.211, χ2 (11) = 116.072, p = < .001. The model explained 79.03% of the variation in the grouping variable. The pooled within-groups correlations showed the highest influence of discriminating function for the secondary MR findings over metabolite indices and hippocampal volumes, the overall predictive accuracy was 93.9%. Due of the large number of variables (qualitative and quantitative) to which a radiologist is exposed in a conventional hippocampal MR-report, such evaluation might benefit from the use of predictive models generated by unconventional statistical methods, such as DA.Schweizerische medizinische Wochenschrift 01/2012; 142:w13549. · 1.68 Impact Factor
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ABSTRACT: INTRODUCTION: We studied the contribution of interictal FDG-PET ([18 F] fluorodeoxyglucose-positron emission tomography) in epileptic focus identification in temporal lobe epilepsy patients with positive, equivocal and negative magnetic resonance imaging (MRI). METHODS: Ninety-eight patients who underwent surgical treatment for drug resistant temporal lobe epilepsy after neuropsychological evaluation, scalp video EEG monitoring, FDG-PET, MRI and/or long-term intracranial EEG and with >12 months clinical follow-up were included in this study. FDG-PET findings were compared to MRI, histopathology, scalp video EEG and long-term intracranial EEG monitoring. RESULTS: FDG-PET lateralized the seizure focus in 95 % of MRI positive, 69 % of MRI equivocal and 84 % of MRI negative patients. There was no statistically significant difference between the surgical outcomes among the groups with Engel class I and II outcomes achieved in 86 %, 86 %, 84 % of MRI positive, equivocal and negative temporal lobe epilepsy patients, respectively. The patients with positive unilateral FDG-PET demonstrated excellent postsurgical outcomes, with 96 % Engel class I and II. Histopathology revealed focal lesions in 75 % of MRI equivocal, 84 % of MRI positive, and 23 % of MRI negative temporal lobe epilepsy cases. CONCLUSION: FDG-PET is an accurate noninvasive method in lateralizing the epileptogenic focus in temporal lobe epilepsy, especially in patients with normal or equivocal MRIs, or non-lateralized EEG monitoring. Very subtle findings in MRI are often associated with histopathological lesions and should be described in MRI reports. The patients with negative or equivocal MRI temporal lobe epilepsy are good surgical candidates with comparable postsurgical outcomes to patients with MRI positive temporal lobe epilepsy.Neuroradiology 12/2012; · 2.70 Impact Factor