Superselective anterior temporal resection in mesial temporal lobe epilepsy

Joacir Graciolli Cordeiro, Kathrin Wagner, Michael Trippel, Josef Zentner, Andreas Schulze-Bonhage

Research output: Contribution to journalReview articlepeer-review

Abstract

We report the case of a patient with pharmacoresistant mesial temporal lobe epilepsy presenting psychomotor seizures with onset at early childhood. MRI showed a blurred internal structure of the right hippocampus and right mammillary body atrophy. Neuropsychological testing revealed deficits in selective attention and visual planning. Non-invasive recordingwas not sufficient to precisely detect the seizure onset zone. Invasive recording showed seizure onset in the temporo-polar neocortex, with spread to the amygdalum and hippocampus. A superselective resection of the temporal pole and amygdalum was performed with preservation of the hippocampus. Histology revealed the presence of focal cortical dysplasia (Palmini type Ib). Seizure frequency was reduced after surgery, and seizure freedom for two years was achieved with optimisation of the antiepileptic drug regime. Memory functions were preserved, and selective attention and visual planning improved following limited resection. This case suggests that, in selected cases, highly targeted resections with preservation of memory-relevant structures may be the best choice considering both seizure control and unimpaired cognitive functioning.

Original languageEnglish (US)
Pages (from-to)284-290
Number of pages7
JournalEpileptic Disorders
Volume13
Issue number3
DOIs
StatePublished - Sep 2011
Externally publishedYes

Keywords

  • Epilepsy
  • Epilepsy surgery
  • Focal cortical dysplasia
  • Mesial
  • Resection
  • Temporal lobe

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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