Document Detail


Surgical outcome in patients with epilepsy and dual pathology.
MedLine Citation:
PMID:  10355666     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
High-resolution MRI can detect dual pathology (an extrahippocampal lesion plus hippocampal atrophy) in about 5-20% of patients with refractory partial epilepsy referred for surgical evaluation. We report the results of 41 surgical interventions in 38 adults (mean age 31 years, range 14-63 years) with dual pathology. Three patients had two operations. The mean postoperative follow-up was 37 months (range 12-180 months). The extrahippocampal lesions were cortical dysgenesis in 15, tumour in 10, contusion/infarct in eight and vascular malformation in five patients. The surgical approach aimed to remove what was considered to be the most epileptogenic lesion, and the 41 operations were classified into lesionectomy (removal of an extrahippocampal lesion); mesial temporal resection (removal of an atrophic hippocampus); and lesionectomy plus mesial temporal resection (removal of both the lesion and the atrophic hippocampus). Lesionectomy plus mesial temporal resection resulted in complete freedom from seizures in 11/15 (73%) patients, while only 2/10 (20%) patients who had mesial temporal resection alone and 2/16 (12.5%) who had a lesionectomy alone were seizure-free (P < 0.001). When classes I and II were considered together results improved to 86, 30 and 31%, respectively. Our findings indicate that in patients with dual pathology removal of both the lesion and the atrophic hippocampus is the best surgical approach and should be considered whenever possible.
Authors:
L M Li; F Cendes; F Andermann; C Watson; D R Fish; M J Cook; F Dubeau; J S Duncan; S D Shorvon; S F Berkovic; S Free; A Olivier; W Harkness; D L Arnold
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Brain : a journal of neurology     Volume:  122 ( Pt 5)     ISSN:  0006-8950     ISO Abbreviation:  Brain     Publication Date:  1999 May 
Date Detail:
Created Date:  1999-06-15     Completed Date:  1999-06-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372537     Medline TA:  Brain     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  799-805     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Analysis of Variance
Atrophy
Electroencephalography
Epilepsy / pathology,  physiopathology,  surgery*
Female
Follow-Up Studies
Hippocampus / pathology*,  physiopathology
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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