title: Efficacy of temporal lobe surgery for epilepsy in patients with negative MRI for mesial temporal lobe sclerosis.
abstract: Epilepsy surgery is a successful treatment for refractory temporal lobe epilepsy (TLE). Reports suggest fewer seizure-free outcomes for patients with TLE and who have a negative brain MRI (nMRI) for mesial temporal sclerosis. Data were collected prospectively from patients with nMRI who underwent temporal lobe surgery for TLE characterized by unilateral ictal temporal lobe seizure onset based on a scalp video electroencephalogram or invasive subdural electrode recordings. A total of 86 patients were followed for at least 24 months after surgery. Outcome was evaluated using the Engel classification. Seizure control was obtained by 55% (47/86) of patients (Class [CL]-I), 27% (23/86) showed significant improvement (CL-II) and 19% (16/86) were deemed surgical failures. Shorter duration of epilepsy, later onset of seizures, and ictal theta rhythm (5-7 Hz) were the most significant predictors of postoperative seizure control. Although hypometabolism on positron emission tomography scan and significant memory disparity (>2.5/8) were not significant prognosticators independently, cumulatively they were predictors for favorable outcome.
authors.affiliation: Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, Florida 33606, USA. fvale@health.usf.edu
authors.forename: Fernando L
authors.initials: FL
authors.lastname: Vale
authors.forename: Euclides
authors.initials: E
authors.lastname: Effio
authors.forename: Nicolas
authors.initials: N
authors.lastname: Arredondo
authors.forename: Ali
authors.initials: A
authors.lastname: Bozorg
authors.forename: Kondi
authors.initials: K
authors.lastname: Wong
authors.forename: Carlos
authors.initials: C
authors.lastname: Martinez
authors.forename: Katheryne
authors.initials: K
authors.lastname: Downes
authors.forename: William O
authors.initials: WO
authors.lastname: Tatum
authors.forename: Selim R
authors.initials: SR
authors.lastname: Benbadis
mesh_terms: D000328:Adult; D000368:Aged; D038481:Anterior Temporal Lobectomy / Q000379:methods; D001925:Brain Damage, Chronic / Q000150:complications / Q000473:pathology / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012598:Sclerosis / Q000150:complications / Q000473:pathology / Q000601:surgery; D013702:Temporal Lobe / Q000473:pathology* / Q000601:surgery*