Epilepsia
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Multicenter Study Comparative Study
Differential effects of temporal pole resection with amygdalohippocampectomy versus selective amygdalohippocampectomy on material-specific memory in patients with mesial temporal lobe epilepsy.
In the surgical treatment of mesial temporal lobe epilepsy, there is converging evidence that individually tailored or selective approaches have a favorable cognitive outcome compared to standard resections. There is, however, also evidence that due to collateral damage, selective surgery can be less selective than suggested. As part of a prospective transregional research project the present study evaluated the outcome in memory and nonmemory functions, following two selective approaches: a combined temporal pole resection with amygdalohippocampectomy (TPR+) and transsylvian selective amygdalohippocampectomy (SAH). ⋯ The results indicate a differential effect of left/right SAH versus TPR+ on material-specific memory insofar as transsylvian SAH appears to be favorable in right and TPR+ in left MTLE. The different outcomes are discussed in terms of a different surgical affection of the temporal pole and stem, and different roles of these structures for verbal and figural memory.
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Multicenter Study Comparative Study
Defining the spectrum of international practice in pediatric epilepsy surgery patients.
The Pediatric Epilepsy Surgery Sub-commission of the International League Against Epilepsy conducted a survey to determine the frequency of epilepsy procedures and etiologies. ⋯ The results of this international survey show the feasibility of international collaborations in determining epilepsy etiologies and procedures in children, and suggest differences in clinical practice between regions of the world. These results can guide the design of future studies in producing guidelines for therapy-resistant pediatric epilepsy surgery patients.
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Comparative Study
Intralesional recordings and epileptogenic zone in focal polymicrogyria.
Polymicrogyria (PMG) is recognized as an epileptogenic lesion but few data concerning organization of the epileptogenic zone (EZ) are available. ⋯ Although intralesional recordings demonstrated intrinsic epileptogenicity in PMG, our data provide evidence that unilateral focal PMG belongs to a large epileptogenic network extending beyond the MRI lesion. SEEG may be helpful for planning surgery with favorable outcome, providing large resections are feasible, even in apparently focal PMG.
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Temporal lobe epilepsy (TLE) in early life is often a catastrophic disorder with pharmacoresistant seizures and secondary neurological deterioration. there is little data available regarding epilepsy surgery performed in infants and young children and no prior study has focused on tle. ⋯ TLE presents in early life with varied and severe manifestations. Excisional procedures in this age group are associated with favorable seizure reduction similar to older children and in adults.
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Biography Historical Article
From lateral to mesial: the quest for a surgical cure for temporal lobe epilepsy.
A gap of more than a hundred years occurred between the first accounts of mesial temporal sclerosis and recognition of its role in the pathogenesis of psychomotor seizures. This paper reviews how the understanding and surgical treatment of temporal lobe epilepsy developed, particularly from the work of Penfield, Jasper, and their associates at the Montreal Neurological Institute (MNI). ⋯ The collaborative work of a team led by Penfield and Jasper at the MNI helped to define the role of neurophysiological studies in epilepsy surgery. As a result, the importance of removing the mesial structures in order to obtain better seizure control in patients with temporal lobe epilepsy became firmly established.