title: Thalamotemporal alteration and postoperative seizures in temporal lobe epilepsy.
abstract: OBJECTIVE
  There are competing explanations for persistent postoperative seizures after temporal lobe surgery. One is that 1 or more particular subtypes of mesial temporal lobe epilepsy (mTLE) exist that are particularly resistant to surgery. We sought to identify a common brain structural and connectivity alteration in patients with persistent postoperative seizures using preoperative quantitative magnetic resonance imaging and diffusion tensor imaging (DTI).
  
  
  METHODS
  We performed a series of studies in 87 patients with mTLE (47 subsequently rendered seizure free, 40 who continued to experience postoperative seizures) and 80 healthy controls. We investigated the relationship between imaging variables and postoperative seizure outcome. All patients had unilateral temporal lobe seizure onset, had ipsilateral hippocampal sclerosis as the only brain lesion, and underwent amygdalohippocampectomy.
  
  
  RESULTS
  Quantitative imaging factors found not to be significantly associated with persistent seizures were volumes of ipsilateral and contralateral mesial temporal lobe structures, generalized brain atrophy, and extent of resection. There were nonsignificant trends for larger amygdala and entorhinal resections to be associated with improved outcome. However, patients with persistent seizures had significant atrophy of bilateral dorsomedial and pulvinar thalamic regions, and significant alterations of DTI-derived thalamotemporal probabilistic paths bilaterally relative to those patients rendered seizure free and controls, even when corrected for extent of mesial temporal lobe resection.
  
  
  CONCLUSIONS
  Patients with bihemispheric alterations of thalamotemporal structural networks may represent a subtype of mTLE that is resistant to temporal lobe surgery. Increasingly sensitive multimodal imaging techniques should endeavor to transform these group-based findings to individualize prediction of patient outcomes.
authors: Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Radiology, Walton Centre National Health Service Foundation Trust, Liverpool, United Kingdom; Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, London, United Kingdom.
authors: Simon S
authors: SS
authors: Keller
authors: Mark P
authors: MP
authors: Richardson
authors: Jan-Christoph
authors: JC
authors: Schoene-Bake
authors: Jonathan
authors: J
authors: O'Muircheartaigh
authors: Samia
authors: S
authors: Elkommos
authors: Barbara
authors: B
authors: Kreilkamp
authors: Yee Yen
authors: YY
authors: Goh
authors: Anthony G
authors: AG
authors: Marson
authors: Christian
authors: C
authors: Elger
authors: Bernd
authors: B
authors: Weber
mesh_terms: D000328:Adult; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology; D013702:Temporal Lobe / Q000473:pathology* / Q000601:surgery*; D013788:Thalamus / Q000473:pathology*; D016896:Treatment Outcome
references: J Neurol Neurosurg Psychiatry. 2012 Dec;83(12):1238-48
references: 22917671
references: Epilepsy Res. 1990 May-Jun;6(1):56-65
references: 2357956
references: Zentralbl Neurochir. 2002;63(3):106-10
references: 12457335
references: Epilepsia. 2006 Jan;47(1):98-107
references: 16417537
references: Epilepsia. 2010 Sep;51(9):1801-8
references: 20738385
references: Ann Neurol. 1992 Feb;31(2):138-46
references: 1575452
references: Brain. 2007 Feb;130(Pt 2):548-60
references: 16959818
references: Epilepsia. 2001 Oct;42(10):1288-307
references: 11737164
references: Neuroimage. 2009 Jul 1;46(3):569-76
references: 19289170
references: Epilepsia. 2014 Feb;55(2):306-15
references: 24447099
references: Brain. 2005 Feb;128(Pt 2):395-404
references: 15634733
references: Acta Neuropathol. 2007 Mar;113(3):235-44
references: 17221203
references: Neurology. 1995 Jul;45(7):1358-63
references: 7617198
references: Acta Neurochir (Wien). 2012 Aug;154(8):1327-36
references: 22722378
references: Epilepsia. 2012 Apr;53(4):733-40
references: 22360822
references: Epilepsia. 2008 Aug;49(8):1296-307
references: 18410360
references: Arch Neurol. 1995 Feb;52(2):173-8
references: 7848127
references: Neurology. 2005 Oct 11;65(7):1094-7
references: 16217065
references: Brain. 2004 Sep;127(Pt 9):2018-30
references: 15215219
references: Neuroimage. 2003 Jul;19(3):1233-9
references: 12880848
references: Epilepsia. 1997 May;38(5):588-94
references: 9184605
references: Nat Rev Neurol. 2012 Dec;8(12):669-77
references: 22964510
references: Lancet. 2011 Oct 15;378(9800):1388-95
references: 22000136
references: Neurology. 2013 Nov 19;81(21):1840-7
references: 24142475
references: Neurology. 2013 Nov 5;81(19):1704-10
references: 24107863
references: Neuroimage. 2007 Oct 15;38(1):95-113
references: 17761438
references: Epilepsia. 2008 May;49(5):741-57
references: 18177358
references: Brain. 2006 Jul;129(Pt 7):1917-28
references: 16760199
references: Neurology. 2010 Jun 1;74(22):1776-84
references: 20513813
references: Epilepsia. 2001 Feb;42(2):282-6
references: 11240604
references: Neurology. 2001 Nov 13;57(9):1636-41
references: 11706104
references: J Comp Neurol. 1986 Jan 15;243(3):409-21
references: 3512627
references: Brain. 2006 Jul;129(Pt 7):1859-71
references: 16672290
references: Epilepsy Res. 2007 May;74(2-3):131-9
references: 17412561
references: Epilepsia. 2011 Jun;52(6):1058-62
references: 21635233
references: Neuroimage. 2010 Jan 1;49(1):71-9
references: 19683060
references: J Neurosurg. 2002 Nov;97(5):1142-51
references: 12450037
references: Epilepsy Res Treat. 2012;2012:201651
references: 22934162
references: Hum Brain Mapp. 2000 Jul;10(3):120-31
references: 10912591
references: N Engl J Med. 2001 Aug 2;345(5):311-8
references: 11484687
references: Epilepsia. 2007 Mar;48(3):571-8
references: 17326795
references: Neurology. 2013 Apr 30;80(18):1669-76
references: 23553475
references: Neuroimage Clin. 2012 Nov 16;2:25-32
references: 24179755
references: Brain. 1996 Jun;119 ( Pt 3):989-96
references: 8673506
references: AJNR Am J Neuroradiol. 1998 Apr;19(4):659-71
references: 9576651
references: Neuroimage. 2002 May;16(1):23-31
references: 11969314
references: Curr Opin Neurol. 2005 Apr;18(2):125-7
references: 15791141
references: Epilepsia. 2011 May;52(5):932-40
references: 21453360
references: Epilepsia. 2001 Aug;42(8):967-78
references: 11554881
references: J Neurol Neurosurg Psychiatry. 2013 Jan;84(1):54-61
references: 23055516
references: Epilepsia. 2000;41 Suppl 6:S3-8
references: 10999511
references: Epilepsia. 2003 Apr;44(4):565-8
references: 12681006
references: Neuroimage. 2000 Jun;11(6 Pt 1):805-21
references: 10860804
references: Hum Brain Mapp. 2014 Sep;35(9):4718-28
references: 24638919