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Objective:To compare the anterior temporal lobectomy (ATL) with transsylvian selective amygdalohippocampectomy (SeAH) in 72 patients with medial temporal lobe epilepsy (MTLE) regarding the seizure control and neuropsychological outcomes.Methods:Clinical data and follow-up data were collected and retrospectively analyzed.SeAH and ATL were used in 39 and 33 patients,respectively.All eligible patients were followed up at least one year.Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised were used to test the patients' neuropsychology before and after the surgery for one year.Results:Fifty-nine patients (81.9％) achieved satisfactory seizure control (62.5％ Engel Class Ⅰ and 19.4％ Class Ⅱ).ATL obtained 84.8％ satisfactory seizure control (28 patients),and the success rate was 79.5％ (31 patients) for SeAH.There was no significant difference in seizure control between SeAH and ATL (P=0.760).The postoperative verbal IQ of SeAH group increased significantly in both side surgery (P＜0.05),while the increase was not significant in the group of ATL of both side surgery (P＞0.05).Regarding left-side surgery,postoperative verbal memory and total memory were increased significantly in the group of SeAH (P＜0.05),while the increases were not significant in the group ofATL (P＞0.05).In the right-side surgery,postoperative verbal memory and total memory were increased significantly in the two surgery strategy groups (P＜0.05),while no significant increases were seen in non-verbal memory of the two surgery strategy groups (P＞0.05).Conclusion:Microsurgery for the treatment of refractory MTLE is successful and safe,and should be encouraged.The seizure outcome is not different between ATL and SeAH,while regarding as verbal IQ and verbal memory outcomes,SeAH may be superior to ATL in dominant hemisphere surgery.
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[ ABSTRACT] AIM:To study the effect of interleukin-1β( IL-1β) on neuron activation during the process of me-dial temporal lobe epilepsy ( MTLE ) .METHODS: IL-1β, rapamycin [ an inhibitor of mammalian target of rapamycin (mTOR)]and lentiviral transfection to knockdown PI3K-p85 were used to pre-treat the neurons.The protein levels of PI3K-p85, p-Akt, p-p70S6K and MAP2 were detected and the relationship among the tested cytokines was analyzed.The neuron endocytosis was observed in each group.RESULTS:IL-1βincreased the protein levels of PI3K-p85, p-Akt and p-p70S6K, up-regulated the expression of PI3K-p85 binding with IL-1RI in the neurons, and increased the neuron endocyto-sis compared with control group (P<0.05) .These processes were inhibited by rapamycin and silence of PI3K-p85 (P<0.05).Inhibition of the PI3K-p85 binding to IL-1RI decreased the protein levels of p-Akt, p-p70S6K and MAP2 which were increased by IL-1βstimulation (P<0.05).CONCLUSION: IL-1βactivates PI3K-p85 by binding with IL-1RI to promote the activation and proliferation of neuron synapses via PI3K/Akt/mTOR signaling pathway, which might be one of the mechanisms in MTLE chronic progress.
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Objective To retrospectively analyze the effect and safety of bilateral stereotactic radiofrequency amygdalohippocampectomy (SAHE) for treatment of bilateral medial temporal lobe epilepsy (BMTLE). Methods Twelve BMTLE patients were treated with bilateral SAHE under limited coagulations. Clinical parameters were evaluated with the programs of Engel′s classification, Liverpool Seizure Severity Scale (LSSS) 2.0, Wechsler Adult Intelligence Scale-Revised (WAIS-R) and Wechsler Memory Scale-Revised (WMS-R), respectively. Results Five patients (42%) were assessed as EngelⅠwith 12 ~ 62-month follow-up. Seizure severity scores were declined sharply compared with the baseline of the patients with out seizure free. Function of memory and intelligence was transiently declined without statistical significance immediately after operation (P >0.05), but was significantly increasedat 6 months after operation (P < 0.05). Conclusion Bilateral SAHE could terminate seizures or reduce seizure severity in patients with BMTLE. Under the circumstance of limited coagulations, neuropsychological function was improved along with seizure control.
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Objective To explore the incidence and imageological features of patients with the hippocampal sclerosis-associated medial temporal lobe epilepsy. Methods Seventy-eight patients with the medial temporal lobe epi?lepsy were recruited from our hospital during February 2012 to December 2013. Magnetic resonance imaging (MRI) and resonance spectroscopy (MRS) analysis were conducted in patients with with the hippocampal sclerosis-associated medial temporal lobe epilepsy, patients with epilepsy without the medial temporal lobe diseases and healthy controls. Results The incidence of hippocampal sclerosis was 58.97%among patients with medial temporal lobe epilepsy which were significantly higher compared with either healthy control group or patients with epilepsy without the medial tempo?ral lobe diseases. The average hippocampal volume of the medial temporal lobe epilepsy group(2305.68±814.61 mm3、2456.71±743. 60 mm3)was significantly smaller compared with either healthy controls or patients with epilepsy without the medial temporal lobe diseases. MRI revealed increased T2WI signal and hippocampal atrophy in 74.55%of patients with hippocampal sclerosis-associated medial temporal lobe epilepsy. Sclerosis was detected on the left side (52.17%) and bilateral hippocampus (19.57%). MRS showed that NAA/(Cr ± Cho) significantly reduced (0.58± 0.19) in the hip?pocampal sclerosis. Conclusions Hippocampal sclerosis may be the main imaging features of the medial temporal lobe epilepsy which are characterized by the hippocampal atrophy and high T2WI signal.
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Introducción. En la literatura científica revisada prevalece una discordancia en las investigaciones sobre la relación entre la memoria subjetiva y objetiva en pacientes con Epilepsia del Lóbulo Temporal medial intratable (ELTmi). Objetivo. Identificar la existencia o no de relación entre la memoria subjetiva y objetiva episódica en pacientes con ELTmi. Metodología. Se estudiaron 32 pacientes, con edades entre 15 y 60 años, empleándose el método clínico. Se aplicó una entrevista semiestructurada, el Cuestionario de Eficiencia de Memoria; el Test de aprendizaje verbal-auditivo de Rey y el Test de reproducción y copia de la figura compleja de Rey-Osterreith. Se realizó el procesamiento de los datos obtenidos. Resultados. Los pacientes reportaron quejas sobre su memoria. La modalidad viso-perceptual se mostró preservada, no así en la verbal-auditiva. No existieron diferencias en función de la lateralización de la zona de inicio ictal para ambas modalidades. Se evidenció una correlación negativa entre la memoria subjetiva y la estabilidad de la huella (modalidad verbal-auditiva). Los pacientes con lateralización izquierda mostraron correlación positiva entre la memoria subjetiva y el recuerdo demorado (modalidad viso-perceptual). Conclusiones. Los pacientes mostraron afectación de la memoria subjetiva, independientemente de la lateralización. También revelaron un perfil heterogéneo en la memoria objetiva episódica; así como la existencia de relación entre la memoria subjetiva y la objetiva episódica en la estabilidad de la huella (modalidad verbal-auditiva) y el recuerdo demorado (modalidad viso-perceptual) solo en los pacientes con lateralización izquierda.
Introduction. In the scientific literature there is not agreement about the existence of relationship between subjective memory and the episodic objective memory in untreatable medial temporal lobe epileptic patients (UMTLE). Objective. To identify the presence of relationship between subjective memory and the episodic objective memory in UMTLE patients. Methods. We studied 32 patients, aged 15-60; all of them were interviewed using a semiestructured interview model and a Questionnaire of Memory Efficiency; the Rey´s Auditory Verbal Learning Test and the Reproduction and copy of complex figure Rey-Osterreith. Test data were analyzed. Results. Patients complained about their memory, viso-perceptual modality was preserved but verbal-auditive modality did not. We didnot find any differences related to the lateralization of the ictal zone for both modalities. There was a negative correlation between the subjective memory and the verbal-auditive modality. Patients with left side lateralization showed a positive correlation between the subjective memory and the delayed viso-perceptual memory type. Conclusions. Patients had abnormalities in the subjective memory unrelated to the lateralization. They also had an heterogeneous profile in the episodic memory and the existence of relationship between subjective memory and the episodic objective memory (verbal-auditive), and a delayed visoperceptual memory type only in patients with left lateralization.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Middle Aged , Epilepsy, Temporal Lobe/physiopathology , Epilepsy, Temporal Lobe/psychology , Memory , Memory Disorders/physiopathology , Memory Disorders/psychology , Functional Laterality , Memory, Episodic , Self Concept , Surveys and QuestionnairesABSTRACT
PURPOSE: The aims of this study were to find brain regions in which gray matter volume was reduced and to show the capability of voxel-based morphometry (VBM) analysis for lateralizing epileptogenic zones in medial temporal lobe epilepsy (mTLE). The findings were compared with fluorodeoxyglucose positron emission tomography (FDG PET). MATERIALS AND METHODS: MR T1-weighted images of 12 left mTLE and 11 right mTLE patients were compared with those of 37 normal controls. Images were transformed to standard MNI space and averaged in order to create study-specific brain template. Each image was normalized to this local template and brain tissues were segmented. Modulation VBM analysis was performed in order to observe gray matter volume change. Gray matter was smoothed with a Gaussian kernel. After these preprocessing, statistical analysis was performed using statistical parametric mapping software (SPM99). FDG PET images were compared with those of 22 normal controls using SPM. RESULTS: Gray matter volume was significantly reduced in the left amygdala and hippocampus in left mTLE. In addition, volume of cerebellum, anterior cingulate, and fusiform gyrus in both sides and left insula was reduced. In right mTLE, volume was reduced significantly in right hippocampus. In contrast, FDG uptake was decreased in broad areas of left or right temporal lobes in left TLE and right TLE, respectively. CONCLUSIONS: Gray matter loss was found in the ipsilateral hippocampus by modulation VBM analysis in medial temporal lobe epilepsy. This VBM analysis might be useful in lateralizing the epileptogenic zones in medial temporal lobe epilepsy, while SPM analysis of FDG PET disclosed hypometabolic epileptogenic zones.
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Humans , Amygdala , Brain , Cerebellum , Epilepsy, Temporal Lobe , Hippocampus , Positron-Emission Tomography , Temporal LobeABSTRACT
OBJECTIVE: The authors evaluate the predictability of single voxel proton magnetic resonance spectroscopy(MRS) for hippocampal abnormalities in medial temporal lobe epilepsy(MTLE), lateral temporal lobe epilepsy(latTLE) and extratemporal lobe epilepsy(extraTLE). METHODS: Twenty healthy volunteers and 42 patients with MTLE, 17 with latTLE and 23 with extraTLE, were examined preoperatively with MRS. The NAA/(Cho+Cr) ratios were calculated from the MRS peaks obtained bilaterally from both hippocampi. RESULTS: The mean NAA/(Cr+Cho) ratios showed a stepwise increase from the ipsilateral hippocampus in the MTLE group to the normal control group. In the 42 MTLE patients, the mean NAA/(Cho+Cr) ratio value for the ipsilateral hippocampus was 0.39. This was 17.3% lower than the 0.489 measured for the contralateral hippocampus (p=0.005). This was also significantly lower when compared with the hippocampi of latTLE and extraTLE patients ipsilateral to the epileptogenic zone and also with the normal control group (p< 0.05). The mean ratio value of the contralateral hippocampi was also significantly lower when compared with the normal control group (p=0.000). The mean ratio value measured on postoperative MRS showed little metabolic recovery in the MTLE (from 0.455 to 0.481, p=0.48) compared to the latTLE (from 0.438 to 0.52, p=0.09). CONCLUSION: The MRS might be inconclusive in determining whether the non-epileptogenic hippocampus is affected by epileptiform discharge propagation from the epileptogenic hippocampus or from the remote epileptogenic zone other than the hippocampus. Therefore, physicians should be cautious when determining whether the contralateral hippocampus in MTLE or both hippocampi in neocortical epilepsy is abnormal and whether they should be resected together with the epileptogenic zone.
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Humans , Epilepsy , Healthy Volunteers , Hippocampus , Magnetic Resonance Spectroscopy , Protons , Temporal LobeABSTRACT
BACKGROUND: We aimed to study the regional cerebral PET activation patterns during memory tests in medial temporal lobe epilepsy (mTLE) patients and to see whether the activation study could lateralize memory dominance. METHODS: Participants included 6 right mTLE patients, 6 left mTLE patients, and 6 controls. Language was dominant in the left hemisphere in all the participants. PETs were performed while presenting a set of 30 line drawings of com-mon objects with 4 second intervals between each drawing. After 30 minutes, PETs were repeated while presenting a set of drawings with half of the obejcts changed. RESULTS: During the encoding, activated areas were dispersed in mTLE in the superior frontal gyrus, the primary sensory cortex, the premotor area, the supramarginal and angular gyri ipsilaterally or contralaterally, in addition to the inferior and middle frontal gyri activated in the controls. During the retrieval, activated areas were localized in the bilateral inferior frontal gyri and the right medial temporal area in the controls, but also in the premotor area, the primary sensory cortex, and the angular gyrus in mTLE. In the encoding and also in the retrieval, the activated fields of the prefrontal areas contralateral to the epileptogenic zone became wider compared to the controls and those ipsilateral to the epileptogenic zone became smaller. CONCLUSIONS: Cortical areas involved in the encoding and retrieval of the episodic memory are dispersed and contralaterally lateralized to the epileptogenic zone. Lateralization is most prominent in the prefrontal areas.
Subject(s)
Humans , Brain Mapping , Brain , Electrons , Epilepsy, Temporal Lobe , Memory , Memory, Episodic , Positron-Emission Tomography , Temporal LobeABSTRACT
BACKGROUNDS: The Wada test is a useful method in predicting the laterality of a epileptogenic zone. However, past research reveals that material specificity has an influence on the lateralization We examined the material-specificity of memory and its change in epileptic patients to discover reasonable items on the Wada test for the proper lateralization of the epileptogenic zone. METHODS: We analyzed 45 patients with video-EEG-confirmed medial temporal lobe epilepsy (mTLE) and definite hippocampal atrophy by an MRI. Eight items were presented during the Wada test including 3 common objects, 1 geometric object, 1 color, 1 word, 1 phrase, and 1 math expression. We checked recognition memo-ry after recovery of hemiparesis and normalization of EEG. RESULTS: For the right mTLE group, recognition memory following a right hemisphere injection was significantly better than a left hemisphere injection for all categories. For the left mTLE group, a significant difference of scores was found for the left versus right hemisphere injection for common objects. When injected to the left hemisphere, all the items helped lateralization, but when injected to the right hemisphere, a phrase did not help with lateralization. CONCLUSIONS: Items with strong unilateral encodings do not help lateralizing the epileptogenic zone.