Chirurgia dell'epilessia temporale farmacoresistente: Differenti strategie chirurgiche dopo un protocollo diagnostico non invasivo

Translated title of the contribution: Temporal lobe epilepsy surgery: Different surgical strategies after a non-invasive diagnostic protocol

G. Di Gennaro, P. P. Quarato, A. Mascia, A. Picardi, A. Sparano, L. G. Grammaldo, N. G. Meldolesi, T. Giampà, C. Falco, F. Sebastiano, M. Manfredi, G. Cantore, V. Esposito

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

A non-invasive presurgical protocol for temporal lobe epilepsy (TLE) based on 'anatomo-electro-clinical correlations' was tested. All consecutive patients with suspected TLE and seizure history > 2 years were entered in the protocol which included video-EEG monitoring and MRI. Three different TLE sub-syndromes (mesial, lateral, mesio-lateral) were identified by means of a combination of anatomical, electrical and clinical criteria. A tailored operation for each sub-syndrome was offered. Patients with seizure history <2 years, MRI evidence of temporal mass lesion and concordant interictal EEG and clinical data by-passed video-EEG monitoring and were directly scheduled for surgery. Lesionectomy was performed without video-EEG recording in 11 tumoral TLE patients. Of 146 patients studied with video-EEG, 133 received a diagnosis of TLE. Four of them were excluded for neuropsychological risks, 8 refused surgery, and 121 were operated. Of 132 consecutive patients who underwent surgery, 101 had at least 1 year of follow-up. They were divided in an 'hippocampal sclerosis/cryptogenic' group (n = 57) and a 'tumours/cortical organization disorders group' (n = 44). In the first group, extensive temporal lobectomy (ETL) was performed in 40 patients, antero-mesial temporal lobectomy (AMTL) in 17 patients. At follow-up, 47 (82.5%) patients were seizure-free. In the second group, lesionectomy plus ETL was performed in 23 patients, lesionectomy plus AMTL in 6 patients, and lesionectomy alone in 15 patients. Thirtynine (88.6%) patients were seizure-free. Our findings suggest that different TLE sub-syndromes can be accurately identified using non-invasive anatomo-electro-clinical data and can be effectively and safely treated with a 'tailored' operation.

Original languageItalian
Pages (from-to)109-112
Number of pages4
JournalBollettino - Lega Italiana contro l'Epilessia
Issue number129-130
Publication statusPublished - 2005

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Temporal Lobe Epilepsy
Electroencephalography
Seizures
Video Recording
Sclerosis

ASJC Scopus subject areas

  • Clinical Neurology

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Chirurgia dell'epilessia temporale farmacoresistente : Differenti strategie chirurgiche dopo un protocollo diagnostico non invasivo. / Di Gennaro, G.; Quarato, P. P.; Mascia, A.; Picardi, A.; Sparano, A.; Grammaldo, L. G.; Meldolesi, N. G.; Giampà, T.; Falco, C.; Sebastiano, F.; Manfredi, M.; Cantore, G.; Esposito, V.

In: Bollettino - Lega Italiana contro l'Epilessia, No. 129-130, 2005, p. 109-112.

Research output: Contribution to journalArticle

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abstract = "A non-invasive presurgical protocol for temporal lobe epilepsy (TLE) based on 'anatomo-electro-clinical correlations' was tested. All consecutive patients with suspected TLE and seizure history > 2 years were entered in the protocol which included video-EEG monitoring and MRI. Three different TLE sub-syndromes (mesial, lateral, mesio-lateral) were identified by means of a combination of anatomical, electrical and clinical criteria. A tailored operation for each sub-syndrome was offered. Patients with seizure history <2 years, MRI evidence of temporal mass lesion and concordant interictal EEG and clinical data by-passed video-EEG monitoring and were directly scheduled for surgery. Lesionectomy was performed without video-EEG recording in 11 tumoral TLE patients. Of 146 patients studied with video-EEG, 133 received a diagnosis of TLE. Four of them were excluded for neuropsychological risks, 8 refused surgery, and 121 were operated. Of 132 consecutive patients who underwent surgery, 101 had at least 1 year of follow-up. They were divided in an 'hippocampal sclerosis/cryptogenic' group (n = 57) and a 'tumours/cortical organization disorders group' (n = 44). In the first group, extensive temporal lobectomy (ETL) was performed in 40 patients, antero-mesial temporal lobectomy (AMTL) in 17 patients. At follow-up, 47 (82.5{\%}) patients were seizure-free. In the second group, lesionectomy plus ETL was performed in 23 patients, lesionectomy plus AMTL in 6 patients, and lesionectomy alone in 15 patients. Thirtynine (88.6{\%}) patients were seizure-free. Our findings suggest that different TLE sub-syndromes can be accurately identified using non-invasive anatomo-electro-clinical data and can be effectively and safely treated with a 'tailored' operation.",
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AU - Mascia, A.

AU - Picardi, A.

AU - Sparano, A.

AU - Grammaldo, L. G.

AU - Meldolesi, N. G.

AU - Giampà, T.

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