Epilepsia
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Because more selective and individual versus extended standard surgery in the treatment of epilepsy appears to result in similar seizure outcomes, the issue of sparing nonlesional and hypothetically still-functioning tissues has become a central topic in epilepsy surgery. Within this framework we hypothesized that surgery in magnetic resonance imaging (MRI)- and histopathologically negative patients with temporal lobe epilepsy (TLE) may serve as a proof of principle about the negative cognitive consequences of resecting nonlesional tissue. ⋯ Preoperative group differences in memory and the finding that, after surgery, both groups had comparably poor performance levels indicate a major relevance of morphologic structural lesions for memory impairment in TLE. The findings in particular confirm the negative impact of the resection of nonlesional functional tissue for cognitive surgical outcome. Absence of MRI lesion and unimpaired memory appear as significant risk factors for postoperative memory loss in temporal lobe surgery.
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Although gamma-knife radiosurgery (GKS) has proved efficacious in temporal lobe epilepsy (TLE), its antiepileptic mechanism of action remains elusive. Human and experimental data suggest that subnecrotic radiation-induced tissue changes might contribute to the antiepileptic effect of GKS. However, there are no data regarding the evolution of electroencephalography (EEG) activity within GKS-treated hippocampus, information that aid in better understanding both the mechanism of action and the reason for failure of GKS treatment. ⋯ Our study shows that mesial temporal structures previously treated with GKS can demonstrate a persistent high degree of epileptiform activity in patients who failed to respond to that treatment. Although this persistent EEG activity appears likely to reflect GKS-induced brain changes, its relation to GKS seizure outcome remains unclear.
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Lennox-Gastaut syndrome (LGS) is an intractable childhood-onset epileptic encephalopathy. Seizure freedom is rare in LGS. One of the hallmarks of LGS is medical intractability, with generally poor response to antiepileptic drugs (AEDs). ⋯ New AEDs have been validated in randomized, controlled trials for the treatment of seizures in LGS. In some cases, nonpharmacologic options may be effective, although more data are needed to confirm efficacy outcomes. Comprehensive patient assessments are critical to achieve an optimal AED treatment regimen and minimize the potential for adverse effects.