Unilateral anterior temporal lobectomy in patients with bilateral temporal lobe epilepsy and dominant seizure-onset in unilateral temporal lobe_Journal of Epilepsy

Authors：

 ZHANGShaohui ¹ , ZHANGJunchen ² , HUXiaohong ³ , YUXiaoman ¹ , KONGHaibo ¹ , GAOChao ¹ ,  LIANGShuli ¹

1. Neurosurgery Department, First Affiliated Hospital of PLA General Hospital, Beijing, 100048, China;
2. ;
3. ;

Corresponding author：

LIANGShuli, Email: liangsl304@hotmail.com

Keywords：

Bilaterior temporal lobe epilepsy; Unilateral anterior temporal lobectomy; Medicine treatment; Quality of life

DOI：

10.7507/2096-0247.20150007

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Objectives To study surgical outcomes and safety of unilateral anterior temporal lobectomy (ATL) in patients with intractable bilateral temporal lobe epilepsy (TLE) and dominant seizure-onset in unilateral temporal lobe. Methods Twenty three carefully selected patients with bilaterial TLE and dominant seizure-onset in unilateral temporal lobe were enrolled and divided into surgery and medicine groups according to the treatment.Seizure control were recorded for 2 to 5 years.Changes of full scale of intelligence quotient(IQ),and overall quality of life (QOL),percentage of therapeutic satisfaction,and surgical complications were analyzed 2 years after enrolling. Results Favor seizure control (Engel Class I and Class Ⅱ) reached 66.7% (10/15),60% (9/15),and 50% (5/10) at 1,2 and 5 years follow-up after unilateral ATL respectively,the percentages in medicine group is 12.5%,0% and 0% accordingly,and there were significant differences in seizures controls between patients with unilateral ATL and cases with medicine.Significantly differences were also found in changes of patients'QOL and full scale IQ at 2 years follow-up between surgery and medicine groups,and average score of overall QOL improved 5.27±6.45 in surgery group,and declined 1.40±3.58 in medicine group.In ATL group,patients with short preoperative history of seizure presented more favor seizure control than those with long preoperative history,and patients with favor seizure control and short preoperative history of seizure had more chance to improve QOL and IQ after ATL. Conclusion Intracranial EEG is vital in diagnosis of bilateral TLE.Unilateral ATL presents favor seizure control and did not render serious memory and IQ injury in carefully selected patients with true bilateral TLE and dominant seizure-onset in unilateral temporal lobe.

Citation： ZHANGShaohui, ZHANGJunchen, HUXiaohong, YUXiaoman, KONGHaibo, GAOChao, LIANGShuli. Unilateral anterior temporal lobectomy in patients with bilateral temporal lobe epilepsy and dominant seizure-onset in unilateral temporal lobe. Journal of Epilepsy, 2015, 1(1): 43-47. doi: 10.7507/2096-0247.20150007 Copy

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6.	Jehi LE, Silveira DC, Bingaman W, et al.Temporal lobe epilepsy surgery failures:predictors of seizure recurrence,yield of reevaluation, and outcome following reoperation. J Neurosurg, 2010, 113(6):1186-1194.
7.	Luo H, Zhao Q, Tian Z, et al. Bilateral stereotactic radiofrequency amygdalohippocampectomy for a patient with bilateral temporal lobe epilepsy. Epilepsia, 2013, 54(11):e155-158.
8.	Finegersh A, Avedissian C, Shamim S, et al.Bilateral hippocampal atrophy in temporal lobe epilepsy:effect of depressive symptoms and febrile seizures. Epilepsia, 2011, 52(4):689-697.
9.	Norman S.Is surgery ever indicated in bitemporal epilepsy? In.Miller JW,Silbergeld DL ed. Epilepsy surgery,Principles and controversies.New York,Talyor & Franic Group. 2006, 485-493.
10.	Loesch AM,Feddersen B, Irsel Tezer F,et al. Seizure semiology identifies patients with bilateral temporal lobe epilepsy. Epilepsy Res, 2015, 109:197-202.
11.	Holmes MD, Miles AN, Dodrill CDTayl,et al.Identifying potential surgical candidates in patients with evidence of bitemporal epilepsy. Epilepsia, 2003, 44:1075-1079.
12.	Kagawa K, Iida K, Katagiri M, et al. Successful treatment of mesial temporal lobe epilepsy with bilateral hippocampal atrophy and false temporal scalp ictal onset:a case report. Hiroshima J Med Sci, 2012, 61(2):37-41.
13.	Malter MP, Tschampa HJ, Helmstaedter C,et al.Outcome after epilepsy surgery in patients with MRI features of bilateral ammon's horn sclerosis. Epilepsy Res, 2013, 105(1-2):150-157.
14.	Vonck K, Sprengers M, Carrette E, et al.A decade of experience with deep brain stimulation for patients with refractory medial temporal lobe epilepsy. Int J Neural Syst, 2013, 23(1):1250034.
15.	Curot J, Denuelle M, Busigny T,et al. Bilateral wada test:Amobarbital or propofol? Seizure, 2014, 23:122-128.

1. Kwan P, Arzimanoglou A, Berg AT, et al.Definition of drug resistant epilepsy:consensus proposal by the ad hoc task force of the ILAE commissionon therapeutic strategies. Epilepsia, 2010,51:1069-1077.
2. Vale FL, Pollock G, Benbadis SR. Failed epilepsy surgery for mesial temporal lobe sclerosis:a review of the pathophysiology.Neurosurg Focus, 2012, 32(3):E9.
3. Aghakhani Y, Liu X, Jette N, et al. Epilepsy surgery in patients with bilateral temporal lobe seizures:a systematic review.Epilepsia, 2014, 55(12):1892-1901.
4. Elsharkawy AE, Alabbasi AH, Pannek H, et al. Long-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients. J Neurosurg, 2009, 110(6):1135-1146.
5. Holmes MS, Dodrill CB, Ojemann GA, et al. Outcome following surgery in patients wiht bitemporal interictal epileptiform patterns.Neurology, 1997, 48:1037-1040.
6. Jehi LE, Silveira DC, Bingaman W, et al.Temporal lobe epilepsy surgery failures:predictors of seizure recurrence,yield of reevaluation, and outcome following reoperation. J Neurosurg, 2010, 113(6):1186-1194.
7. Luo H, Zhao Q, Tian Z, et al. Bilateral stereotactic radiofrequency amygdalohippocampectomy for a patient with bilateral temporal lobe epilepsy. Epilepsia, 2013, 54(11):e155-158.
8. Finegersh A, Avedissian C, Shamim S, et al.Bilateral hippocampal atrophy in temporal lobe epilepsy:effect of depressive symptoms and febrile seizures. Epilepsia, 2011, 52(4):689-697.
9. Norman S.Is surgery ever indicated in bitemporal epilepsy? In.Miller JW,Silbergeld DL ed. Epilepsy surgery,Principles and controversies.New York,Talyor & Franic Group. 2006, 485-493.
10. Loesch AM,Feddersen B, Irsel Tezer F,et al. Seizure semiology identifies patients with bilateral temporal lobe epilepsy. Epilepsy Res, 2015, 109:197-202.
11. Holmes MD, Miles AN, Dodrill CDTayl,et al.Identifying potential surgical candidates in patients with evidence of bitemporal epilepsy. Epilepsia, 2003, 44:1075-1079.
12. Kagawa K, Iida K, Katagiri M, et al. Successful treatment of mesial temporal lobe epilepsy with bilateral hippocampal atrophy and false temporal scalp ictal onset:a case report. Hiroshima J Med Sci, 2012, 61(2):37-41.
13. Malter MP, Tschampa HJ, Helmstaedter C,et al.Outcome after epilepsy surgery in patients with MRI features of bilateral ammon's horn sclerosis. Epilepsy Res, 2013, 105(1-2):150-157.
14. Vonck K, Sprengers M, Carrette E, et al.A decade of experience with deep brain stimulation for patients with refractory medial temporal lobe epilepsy. Int J Neural Syst, 2013, 23(1):1250034.
15. Curot J, Denuelle M, Busigny T,et al. Bilateral wada test:Amobarbital or propofol? Seizure, 2014, 23:122-128.

Journal of Epilepsy

Unilateral anterior temporal lobectomy in patients with bilateral temporal lobe epilepsy and dominant seizure-onset in unilateral temporal lobe

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