Dhiman V, Rao S, Sinha S, Arimappamagan A, Mahadevan A, Bharath RD, Saini J, Jamuna R, Keshav Kumar J, Rao SL, Chandramouli BA, Satishchandra P, Shankar SK. Outcome of lesionectomy in medically refractory epilepsy due to non-mesial temporal sclerosis (non-MTS) lesions.
Clin Neurol Neurosurg 2013;
115:2445-53. [PMID:
24119337 DOI:
10.1016/j.clineuro.2013.09.008]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 08/12/2013] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES
To analyze the seizure outcome of lesionectomy for refractory epilepsy secondary to non-mesial temporal sclerosis (non-MTS) lesions.
METHODS
Sixty-eight patients with non-MTS lesions (M:F=42:26; age at onset: 11.7±9.6 years; age at surgery: 21.1±9.4 years), who underwent lesionectomy for refractory epilepsy were analyzed. The age at onset, frequency/type of seizure, MRI findings, video-EEG, histopathology and Engel's grading at 1 year/last follow up were recorded.
RESULTS
The duration of epilepsy at surgery was 9.9±6.9 years. The location of lesions were: temporal: 41 (60.3%); frontal: 21 (30.9%); parietal: 6 (8.8%). The type of lesionectomies performed were temporal 41 (60.3%), extra-temporal: 25 (36.8%), temporo-frontal and temporo-parietal: 1 (1.5%) patient each. The histopathological diagnosis were neoplastic: 32 (47.1%), cortical dysplasia: 19 (27.9%), other focal lesions: 17 (25%). At mean follow up of 2.9±2.1 years (median: 2.6 years), outcome was - Engel's class I: 43 (63.2%), IIa: 14 (20.6%), III: 7 (10.3%), IV: 4 (5.9%). Good seizure control (Engel's class I/IIa) was achieved in 57 (83.8%) patients. The good prognostic markers included temporal seizures, extended lesionectomy and AEDs after surgery while poor prognostic marker was gliotic lesion on histopathology.
CONCLUSION
Following lesionectomy due to non-MTS lesions, seizure freedom (Engel I) was noted in about 63.2% of patients, which is comparable to other series and reiterates the effectiveness of lesionectomy for seizure control.
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