Clinical characteristics, surgical and neuropsychological outcomes in drug resistant tumoral temporal lobe epilepsy.
BACKGROUND
Glioneuronal tumors are found in nearly one third patients who undergo surgery for pharmacoresistant epilepsy with temporal lobe being the most common location. Few studies, however have concentrated on the neurological and neuropsychological outcomes after surgery, hitherto none from India.


METHODS
We studied 34 patients with temporal lobe tumors and drug resistant epilepsy. These patients underwent anterior temporal lobectomy or lesionectomy based on the involvement of the hippocampus and mesial temporal structures. The clinical history, EEG, neuropsychology profile and MRI were compared. Seizure outcome was categorized using Engel's classification.


RESULTS
At a mean follow up of 62 months, 85.29% of the patients were seizure free (Engel's Class I). All 8 patients with intraoperative electrocorticography (ECoG) guided resection were seizure free.


CONCLUSIONS
Presence of a residual lesion was significantly associated with persistence of seizures post surgery (p = 0.002). Group analysis revealed no significant shifts in IQ and memory scores postoperatively. There was a significant improvement in the quality of life scores (total and across all subdomains) in all patients (p < 0.001). Postoperative EEG abnormalities predicted unfavorable ​seizure outcome.


CONCLUSIONS
Surgery for temporal lobe tumors and refractory epilepsy offers complete seizure freedom in majority. Complete surgical excision of the epileptogenic zone is of paramount importance in achieving seizure freedom. Intraoperative electrocorticography (EcoG) is a useful adjunct to ensure complete removal of epileptogenic zone, thus achieving optimal seizure freedom. There is a significant improvement in the quality of life scores (p < 0.001) with no negative impact of surgery on memory and intelligence. Even the patients who are not seizure free can achieve worthwhile improvement post surgery.
Dept of Neurology, Comprehensive Epilepsy Care Centre, Seth GSMC & KEM Hospital, Parel, Mumbai 400012, India. Electronic address: ravatsh@yahoo.com.
Sangeeta
S
Ravat
Dept of Neurology, Comprehensive Epilepsy Care Centre, Seth GSMC & KEM Hospital, Parel, Mumbai 400012, India. Electronic address: drvivekiyer1984@gmail.com.
Vivek
V
Iyer
Dept of Neurosurgery, Comprehensive Epilepsy Care Centre, Seth GSMC & KEM Hospital, Parel, Mumbai 400012, India. Electronic address: dmuzumdar@hotmail.com.
Dattatraya
D
Muzumdar
Dept of Neurology, Comprehensive Epilepsy Care Centre, Seth GSMC & KEM Hospital, Parel, Mumbai 400012, India. Electronic address: shahurvashi100@gmail.com.
Urvashi
U
Shah
Dept of Neurology, Comprehensive Epilepsy Care Centre, Seth GSMC & KEM Hospital, Parel, Mumbai 400012, India. Electronic address: pranjali.pradhan@googlemail.com.
Pranjali
P
Pradhan
Dept of Neurology, Comprehensive Epilepsy Care Centre, Seth GSMC & KEM Hospital, Parel, Mumbai 400012, India. Electronic address: neeraj2you@gmail.com.
Neeraj
N
Jain
Dept of Neurology, Seth GSMC & KEM Hospital, Parel, Mumbai 400012, India. Electronic address: dryogeshgodge@gmail.com.
Yogesh
Y
Godge
D000293:Adolescent; D000328:Adult; D002648:Child; D004351:Drug Resistance; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D011788:Quality of Life
Amygdalahippocampectomy; Anterior temporal lobectomy (ATL); Drug resistant epilepsy; Electrocorticography (ECoG); Neuropsychological outcomes; Temporal lobe tumors