Outcome after cortico-amygdalo-hippocampectomy in patients with temporal lobe epilepsy and normal MRI.
BACKGROUND
We describe seizure and neuropsychological outcome obtained after CAH in patients with TLE and normal MRI evaluated in the modern imaging era.


METHODS
Forty-five adult consecutive patients with TLE and normal MRI were studied. All patients had neuropsychological testing, interictal and ictal EEG recordings and MRI. They were divided into two groups: Group 1 (n=18), included patients in whom non-invasive neurophysiological evaluation was lateralizing and Group 2 (n=27) included patients with non-lateralizing neurophysiological data who were submitted to invasive recordings.


RESULTS
Seventy-seven percent of the Group 1 patients were rated as Engel I; 11% were rated as Engel II and 11% as Engel III. In Group 2, there were 57% of patients seizure-free, 26% in Engel II and 14% in Engel III. Pre-operatively, mean general IQ was 82 and 78 in Groups 1 and 2, respectively; post-operatively, mean general IQ was respectively 86 and 71. Some degree of verbal memory decline was noted in all patients submitted to dominant temporal lobe resection in both Groups 1 and 2. At last follow-up visit, 22% of Group 1 and 11% of Group 2 patients were receiving no antiepileptic drugs (AED).


CONCLUSIONS
Our data showed that patients with TLE and normal MRI could get good surgical results after CAH although 60% of them would need invasive recordings and their results regarding seizure control and cognition were worse than those obtained in patients with MRI defined temporal lobe lesions. Caution should be taken in offering dominant temporal lobe resection to this subset of patients.
Cukiert
Arthur
A
Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo, SP, Brazil. acukiert@uol.com.br
Burattini
José Augusto
JA
Mariani
Pedro Paulo
PP
Cukiert
Cristine Mella
CM
Argentoni
Meire
M
Baise-Zung
Carla
C
Forster
Cássio Roberto
CR
Mello
Valeria Antakli
VA
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000679:Amygdala / Q000473:pathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery*; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006624:Hippocampus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology; D008569:Memory Disorders / Q000209:etiology / Q000523:psychology / Q000628:therapy; D009483:Neuropsychological Tests; D012640:Seizures / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult