title: Presence of temporal gray-white matter abnormalities does not influence epilepsy surgery outcome in temporal lobe epilepsy with hippocampal sclerosis.
abstract: BACKGROUND
  Temporal lobe gray-white matter abnormalities (GWMA) are frequent morphological aberrances observed on MRI in patients with temporal lobe epilepsy (TLE) in addition to hippocampal sclerosis (HS).
  
  
  OBJECTIVE
  To study the influence of temporal pole GWMA on clinical characteristics and seizure outcome in patients with HS operated on for TLE.
  
  
  METHODS
  A cohort of 370 patients undergoing surgery for intractable TLE was prospectively collected in an epilepsy surgery data base. Clinical characteristics and seizure outcome of all 58 TLE patients with identified HS and GWMA (group 1) were compared with those of a matched control group of 58 HS patients without GWMA (group 2). Both groups were further subdivided into patients undergoing transsylvian selective amygdalohippocampectomy (sAH) and anterior temporal lobectomy with amygdalohippocampectomy (ATL).
  
  
  RESULTS
  The HS plus GWMA patients were significantly younger at epilepsy onset than those without GWMA. In the HS plus GWMA group, 41% of patients were younger than 2 years when they experienced their first seizure in contrast to only 17% of patients with pure HS (P = .004). Seizure outcome was not statistically different between the 2 groups: 75.9% of the patients in group 1 were seizure free (Engel class I) compared with 81% of patients in group 2. Seizure outcome in both groups was about equally successful with selective amygdalohippocampectomy and anterior temporal lobectomy (ns).
  
  
  CONCLUSIONS
  Limited and standard resections in TLE patients with HS are equally successful regardless of the presence of GWMA.
authors.affiliation: Department of Neurosurgery, University of Bonn, Bonn, Germany. o.schijns@mumc.nl
authors.forename: Olaf E M G
authors.initials: OE
authors.lastname: Schijns
authors.forename: Christian G
authors.initials: CG
authors.lastname: Bien
authors.forename: Michael
authors.initials: M
authors.lastname: Majores
authors.forename: Marec
authors.initials: M
authors.lastname: von Lehe
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.forename: Albert
authors.initials: A
authors.lastname: Becker
authors.forename: Johannes
authors.initials: J
authors.lastname: Schramm
authors.forename: Christian E
authors.initials: CE
authors.lastname: Elger
authors.forename: Hans
authors.initials: H
authors.lastname: Clusmann
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D004833:Epilepsy, Temporal Lobe / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D012598:Sclerosis / Q000473:pathology; D013702:Temporal Lobe / Q000002:abnormalities*; D016896:Treatment Outcome; D055815:Young Adult