Anterior temporal lobectomy improved mood status and quality of life in Chinese patients with mesial temporal lobe epilepsy:a single-arm cohort study

Background: Many studies have emphasized that selective resection of epileptic lesions in temoral lobe is associated with better preservation of cognition function;whether this applies to patients with refractory mesial temporal lobe epilepsy (MTLE) remains unknown. The objective of this study was to evaluate changes in cognitive functions, mood status, and quality of life after anterior temporal lobectomy in patients with refractory MTLE. Methods: This single-arm cohort study assessed cognitive function, mood status, and quality of life, as well as electroencephalography findings, in patients with refractory MTLE who underwent anterior temporal lobectomy at Xuanwu Hospital from January 2018 to March 2019. Pre- and post-operative characteristics were compared to evaluate the effects of surgery. Results: Anterior temporal lobectomy significantly reduced the frequencies of epileptiform discharges. The overall success rate of surgery was acceptable. Anterior temporal lobectomy did not result in significant changes in overall cognitive functions (P > 0.05), although changes in certain domains, including visuospatial ability, executive ability, and abstract thinking, were detected. Anterior temporal lobectomy resulted in improvements in anxiety and depression symptoms and quality of life. Conclusions: Anterior temporal lobectomy reduced epileptiform discharges and incidence of post-operative seizures as well as resulted in improved mood status and quality of life without causing significant changes in cognitive function.

Clinical curative effect analysis and predictors of prognosis in patients with temporal lobe epilepsy after anterior temporal lobectomy： results after five years

Background Anterior temporal Iobectomy （ATL） is the most common surgical treatment for temporal lobe epilepsy （TLE）although long-term prognosis is often less favorable than short-term outcomes. This study aimed to examine the outcomes of patients with TLE 5 years after undergoing ATL, and to seek possible predictors of prognosis. Methods We examined the clinical records of 121 patients with TLE who underwent ATL in our institution between January 2005 and December 2008. The Engel seizure classification was used to divide patients into ＂seizure free＂ and ＂non-seizure free＂ groups. Univariate and multivariate Logistic regression analyses were used to identify potential prognostic indicators, including history, clinical features of seizures, and magnetic resonance imaging （MRI） and video- electroencephalography （EEG） findings. Results The majority of patients were seizure free during the follow-up period： 71.9% 1 year after surgery; 71.6% after 2 years; 75.8% after 3 years; 78.8% after 4 years after surgery and 68.8% after 5 years. There were significant differences between seizure-free and non-seizure-free groups in terms of preoperative seizure duration, history of febrile seizures, type of seizure, and MRI and video-EEG findings （P 〈0.05）, but not in terms of sex, age at seizure onset, age at surgery, side of surgery, auras, family history of seizure, or history of traumatic brain injury, perinatal anoxia or intracranial infection history （P 〉0.05）. Multivariate Logistic regression analysis showed that a preoperative seizure duration 〈10 years, a history of febrile seizures, simple complex partial seizures, positive MRI findings, hippocampal sclerosis and unilateral localized video-EEG spikes predicted better outcome （P 〈0.05）. Conclusions ATL appears to be an effective means of treating TLE. Patients undergoing ATL for TLE require careful and comprehensive assessment to ensure optimal outcomes and to allow patients to make informed decisions about their treatment.

Independent temporal lobe epilepsy in patients with tuberous sclerosis complex

Tuberous sclerosis complex(TSC)is a rare disease that involves multiple organs,including the brain;approximately 80%-90%of TSC patients exhibit TSC-associated epilepsy.Independent temporal lobe epilepsy(TLE),TSC-unrelated epilepsy,is particularly rare in patients with TSC.Here,we describe three patients with TSC with independent TLEs that were confirmed by stereo-electroencephalography(EEG),postoperative pathological findings,and seizure outcome at follow-up.The patients were retrospectively enrolled at two centers;their ictal epileptiform discharge onsets were determined using electrode contacts in the hippocampus during stereo-EEG.The three patients underwent anterior temporal lobectomies and remained seizure-free at 1-5 years after surgery.Postoperative pathological examinations confirmed hippocampal sclerosis in all three patients.Furthermore,postoperative intelligence quotient improvement was evident in one patient,while the quality of life was improved in two patients at 12 months after surgery.

Temporal lobe epilepsy with hypothalamic hamartome： a rare case

Refractory gelastic seizure is one of the most common clinical manifestations in patients with hypothalamic hamartoma （HH） and HH is usually regarded as the epileptogenic focus. A young female patient with a small HH and refractory seizures is reported here. However, both the seizure semiology and results of electroencephalogram monitoring indicated the right temporal region was the epileptogenic focus. Thus a standard right anterior temporal Iobectomy was performed while the hamartoma preserved. There was a marked improvement in both seizure frequency and quality of life during a 13-month follow-up. The outcome supported the concept that independent epileptogenic focus outside of the hypothalamus might occur in patients with HH.