Epilepsy surgery outcomes in temporal lobe epilepsy with a normal MRI.

摘要: Partial seizure disorders account for the majority of epilepsy (Sander et al., 1990). In one tertiary center cohort 2,200 patients, partial was more than twice as common symptomatic, cryptogenic, and idiopathic generalized epilepsies combined. Moreover, in that study, two-thirds localized to temporal lobe (Semah 1998). Unfortunately, despite optimal medical therapy, approximately 30% patients continue experience recurrent seizures 1990 Wiebe, al. 2001). a recent well-designed trial studying who failed initial medication trials, freedom achieved only 8% with continued therapy compared 58% undergoing anterior lobectomy (Wiebe, 2001). However, physicians may be reluctant consider surgery when structural neuroimaging appears normal. Temporal has been shown render about 80% seizure-free setting magnetic resonance imaging (MRI)–apparent abnormality concordant onset zone, such mesial sclerosis (MTS) (Cascino, 2004). On other hand, normal MRI have received less attention. order demonstrate absence potentially epileptogenic lesion, it is critical high-resolution protocol both T1- T2-weighted images (Jack, 1996; Cascino, There are relatively few studies examining modern MRI. Existing research suggests significantly disparate rates successful nonlesional MRI, ranging from 18–63% becoming (Berkovic 1995; Theodore 1997; Sylaja 2004; Cohen-Gadol 2005; Jeha 2006). Many these were conducted during 1980s early 1990s Radhakrishnan 1998; McIntosh 2004), prior widespread use protocols sensitive detecting MTS Jack 1996). Some used pathologic findings categorize (McIntosh 2006), information not available preoperatively clinical prognostication. Other include heterogeneous patient populations small numbers (Holmes 2000; 2005). Therefore, we sought examine efficacy noninvasive predictors favorable outcome medically refractory