Clinical and neurophysiological correlations in patients with refractory partial epilepsy and intracranial structural lesions.
Twenty patients (13 males, 7 females), who presented with refractory partial epilepsy and a CT and/or MR detected intracranial intra-axial structural lesion were admitted to the University of Gent Epilepsy Monitoring Unit. Mean duration of the epilepsy was 17 years (2-47 years). All patients were enrolled in a comprehensive presurgical protocol including neurological examination, video-scalp-EEG monitoring with prolonged interictal and ictal recording, neuropsychological assessment and positron emission tomography (PET). Intracranial EEG monitoring was performed in 5 patients in whom discrepancies between different tests were found during the non-invasive evaluation. Clinical neurological examination was normal in 16 patients; 4 patients had a mild contralateral hemiparesis. Lesions were mainly located in the temporal lobe (55%). Most patients presented with complex partial seizures (90%). Clinical seizure characteristics correlated well with the lesion location in 55% of patients. Interictal EEG showed focal epileptic activity and focal slowing in respectively 85% and 30% of patients. Interictal EEG lateralization was congruent with the side of the lesion in 17 patients (85%). Interictal EEG localization was congruent with the lobe of the lesion in 13 patients (65%). Ictal EEG lateralized correctly in 14 patients (70%) and localized correctly in 10 patients (50%). Neuropsychological assessment lateralized and localized congruently in respectively 8/17 (47%) and 7/17 (41%) of patients. Interictal PET showed focal interictal hypometabolism, congruent with the lesion, in 13/16 (81%) of patients. Intracranial EEG was congruent with the lesion location in 3 patients but non-congruent in 2 patients. All patients underwent surgical procedures: average follow-up was 14 months (6-24 months). Complete surgical removal of the lesion with free margins resulted in a more than 90% reduction of seizures without postoperative neurological deficit in 12/13 patients.
Department of Neurology, University Hospital, Gent, Belgium.
P
P
Boon
L
L
Calliauw
J
J
De Reuck
I
I
Hoksbergen
E
E
Achten
E
E
Thiery
J
J
Caemaert
A
A
De Somer
D
D
Decoo
D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014055:Tomography, Emission-Computed