Document Detail

Association of combined MRI, interictal EEG, and ictal EEG results with outcome and pathology after temporal lobectomy.
MedLine Citation:
PMID:  9578527     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Magnetic resonance imaging, interictal scalp EEG, and ictal scalp EEG each have been shown to localize the primary epileptic region in most patients with mesial-basal temporal lobe epilepsy (MBTLE), but the association of surgical outcome and pathology with each combination of these test results is not known. METHODS: We reviewed the MRI, interictal scalp EEG, and ictal scalp EEG results of 90 consecutive patients with MBTLE. Twelve patients were excluded from the analysis because inconclusive bitemporal intracranial EEG results precluded anterior temporal lobectomy (ATL); none had concordant MRI and interictal scalp EEG results. We compared all combinations of presurgical MRI, interictal EEG, and ictal EEG results to seizure outcome and tissue pathology in the 78 patients who underwent an ATL. RESULTS: Forty-eight (61%) patients had concordant lateralized MRI and interictal EEG temporal lobe abnormalities, with no discordant ictal EEG results; 77% of these patients were seizure-free after ATL. Concordance of MRI and interictal EEG abnormalities correlated with seizure cessation (p < 0.05), compared to all combinations with discordant or nonlateralizing MRI and interictal EEG results. Mesial temporal sclerosis (MTS) was confirmed pathologically in about 80% of both groups (p = 0.5). Outcome in patients with concordant MRI and ictal EEG with nonlateralizing interictal EEG was significantly worse than combinations with concordant MRI and interictal EEG (p < 0.02). CONCLUSIONS: Compared to other combinations of test results, concordance of MRI and interictal EEG is most closely associated with surgical outcome in MBTLE. However, most selected patients have pathologic confirmation of MTS regardless of test results or outcome. This information may be useful for planning the presurgical evaluation of patients with medically intractable MBTLE.
F Gilliam; S Bowling; E Bilir; J Thomas; E Faught; R Morawetz; C Palmer; J Hugg; R Kuzniecky
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Epilepsia     Volume:  38     ISSN:  0013-9580     ISO Abbreviation:  Epilepsia     Publication Date:  1997 Dec 
Date Detail:
Created Date:  1998-05-14     Completed Date:  1998-05-14     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1315-20     Citation Subset:  IM    
Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham 35294, USA.
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MeSH Terms
Brain Diseases / pathology
Cohort Studies
Electrodes, Implanted
Epilepsy, Temporal Lobe / diagnosis*,  physiopathology,  surgery*
Functional Laterality / physiology
Magnetic Resonance Imaging*
Middle Aged
Retrospective Studies
Sclerosis / pathology
Temporal Lobe / pathology*,  physiopathology,  surgery*
Treatment Outcome
Grant Support

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