Persistent seizures following left temporal lobe surgery are associated with posterior and bilateral structural and functional brain abnormalities

被引:48
作者
Keller, Simon S.
Cresswell, Paul
Denby, Christine
Wieshmann, Udo
Eldridge, Paul
Baker, Gus
Roberts, Neil
机构
[1] Univ Liverpool, MARIARC, Liverpool L69 3BX, Merseyside, England
[2] Univ Manchester, Sch Psychol Sci, Manchester M13 9PL, Lancs, England
[3] Walton Ctr Neurol & Neurosurg, Dept Neurophysiol, Liverpool, Merseyside, England
[4] Walton Ctr Neurol & Neurosurg, Dept Clin Sci, Liverpool, Merseyside, England
[5] Walton Ctr Neurol & Neurosurg, Dept Neurosurg, Liverpool, Merseyside, England
关键词
epilepsy; neuroimaging; post-surgical seizures; temporal lobectomy; voxel-based morphometry;
D O I
10.1016/j.eplepsyres.2007.02.005
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Purpose: To perform a quantitative MRI and retrospective electrophysiological study to investigate whether persistent post-surgical seizures may be due to brain structural and functional abnormalities in temporal lobe cortex beyond the margins of resection and/or bilateral abnormalities in patients with temporal lobe epilepsy (TLE). Methods: In 22 patients with left TLE and histopathological evidence of hippocampal sclerosis sis, we compared pre-surgical brain morphology between patients surgically remedied (Engel I) and patients with persistent post-surgical seizures (PPS, Engel's II-IV) using voxel-based morphometry (VBM). Routine pre-surgical EEG and invasive and non-invasive telemetry investigations were additionally compared between patient groups. Results: Results indicated widespread structural and functional abnormalities in patients with PPS relative to surgically remedied patients. In particular, patients with PPS had significantly reduced volume of the ipsilateral posterior media[ temporal lobe and contralateral medial. temporal lobe relative to surgically remedied patients. Furthermore, successful surgery was associated with clear anterior (89%) and unilateral (100%) temporal lobe EEG abnormalities, whilst PPS were associated with widespread ipsilateral (91%) and bilateral (82%) temporal lobe abnormalities. Discussion: We suggest that these preliminary data support the hypothesis that PPS after temporal lobe surgery are due to functionally connected epileptogenic cortex remaining in the ipsilateral posterior temporal lobe and/or in temporal lobe contralateral to resection. (C) 2007 Elsevier B.V. All rights reserved.
引用
收藏
页码:131 / 139
页数:9
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