Epilepsy surgery without invasive EEG: early results of a new program

Bittencourt, Paulo R. M. de; Araújo, João C.; Leite, Paulo J. M.; Moro, Marlus S.; Piana, Edson R.; Sandmann, Marcos C.

doi:10.1590/S0004-282X1997000400004

Abstracts

A total of 42 patients were submitted to a clinical, behavioural and neuropsychological evaluation with the objective of eventual surgical treatment of epilepsy refractory to the usual clinical therapies. Prolonged video-EEG monitoring, MRI hippocampal volume measurement, lateralization of speech and memory using the amobarbital (Wada) test were used. Of 18 operated cases, 12 were submitted to temporal lobectomy, with a follow-up of 6-30 months; 8 patients had significant improvement in seizures control; 2 patients had partial improvement in seizure frequency and intensity; 2 patients had no improvement in seizure control. One patient underwent right frontal lobectomy with total remission of seizures and 5 had callosotomy with varying degrees of success. There was no mortality. Morbidity included one subdural hematoma, one transient hemiparesis, one episode of mania, one lobar pneumonia and frequent immediately post-operative muscular tension headaches. These early results indicate good results of temporal lobectomy patients investigated through a non-invasive presurgical evaluation.

epilepsy; epilepsy surgery

No total, 42 pacientes foram submetidos a avaliação clínica, comportamental e neuropsicológica com o objetivo de eventual tratamento cirúrgico de epilepsia refratária aos tratamentos clínicos usuais. Monitorização de vídeo-EEG digital prolongado, avaliação do volume hipocampal por RM, lateralização de fala e memória pelo teste do Amobarbital (teste de Wada) foram utilizados. Dos 18 pacientes operados 12 foram submetidos a lobectomia temporal, com seguimento de 6-30 meses (média 17 meses), sendo que 8 encontram-se com melhora significativa do controle de crises, 2 com melhora parcial e em 2 não foi observada mudança substancial na intensidade e frequência de crises. Uma paciente foi submetida a lobectomia frontal direita com remissão total de crises. Cinco pacientes foram submetidos a calosotomia com graus variáveis de sucesso. Não houve mortalidade. A morbidade incluiu um hematoma subdural, uma hemiparesia transitória, um episódio de mania, uma pneumonia lobar e cefaléia tensional muscular frequente no pós-operatório imediato. Estes resultados preliminares indicam uma boa resposta do tratamento cirúrgico de epilepsia em um novo centro, com pacientes selecionados através de monitorização não invasiva.

epilepsia; cirurgia de epilepsia

Epilepsy surgery without invasive EEG: early results of a new program

Cirurgia de epilepsia sem EEG invasivo: resultados preliminares de um novo programa

Paulo R. M. de Bittencourt^III; João C. Araújo^II; Paulo J. M. Leite^I; Marlus S. Moro^II; Edson R. Piana^I; Marcos C. Sandmann^I

^IProgram of Epilepsy Surgery, Hospital Nossa Senhora da Graças, Curitiba: Neurology Service

^IIProgram of Epilepsy Surgery, Hospital Nossa Senhora da Graças, Curitiba: Neurosurgery Service

^IIIProgram of Epilepsy Surgery, Hospital Nossa Senhora da Graças, Curitiba: Head of Neurology and Neurophysiology Services

ABSTRACT

A total of 42 patients were submitted to a clinical, behavioural and neuropsychological evaluation with the objective of eventual surgical treatment of epilepsy refractory to the usual clinical therapies. Prolonged video-EEG monitoring, MRI hippocampal volume measurement, lateralization of speech and memory using the amobarbital (Wada) test were used. Of 18 operated cases, 12 were submitted to temporal lobectomy, with a follow-up of 6-30 months; 8 patients had significant improvement in seizures control; 2 patients had partial improvement in seizure frequency and intensity; 2 patients had no improvement in seizure control. One patient underwent right frontal lobectomy with total remission of seizures and 5 had callosotomy with varying degrees of success. There was no mortality. Morbidity included one subdural hematoma, one transient hemiparesis, one episode of mania, one lobar pneumonia and frequent immediately post-operative muscular tension headaches. These early results indicate good results of temporal lobectomy patients investigated through a non-invasive presurgical evaluation.

Key-words: epilepsy, epilepsy surgery.

RESUMO

No total, 42 pacientes foram submetidos a avaliação clínica, comportamental e neuropsicológica com o objetivo de eventual tratamento cirúrgico de epilepsia refratária aos tratamentos clínicos usuais. Monitorização de vídeo-EEG digital prolongado, avaliação do volume hipocampal por RM, lateralização de fala e memória pelo teste do Amobarbital (teste de Wada) foram utilizados. Dos 18 pacientes operados 12 foram submetidos a lobectomia temporal, com seguimento de 6-30 meses (média 17 meses), sendo que 8 encontram-se com melhora significativa do controle de crises, 2 com melhora parcial e em 2 não foi observada mudança substancial na intensidade e frequência de crises. Uma paciente foi submetida a lobectomia frontal direita com remissão total de crises. Cinco pacientes foram submetidos a calosotomia com graus variáveis de sucesso. Não houve mortalidade. A morbidade incluiu um hematoma subdural, uma hemiparesia transitória, um episódio de mania, uma pneumonia lobar e cefaléia tensional muscular frequente no pós-operatório imediato. Estes resultados preliminares indicam uma boa resposta do tratamento cirúrgico de epilepsia em um novo centro, com pacientes selecionados através de monitorização não invasiva.

Palavras-chave: epilepsia, cirurgia de epilepsia

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Aceite: 30-maio-1997.

Dr. Paulo R. M. de Bittencourt - Hospital Nossa Senhora das Graças- Rua Alcides Munhoz 443 - 80810-010 - Curitiba PR - Brasil.

1. de Bittencourt PRM. Epileptogênese, estrutura e função cerebral na epilepsia do lobo temporal: um estudo prospectivo controlado. Thesis for the Degree of Professor of Medicine (Neurology) Universidade Federal do Paraná Curitiba, 1991.
2. de Bittencourt PRM, Antoniuk SA, Bigarella MM, et al. Carbamazepine and phenytoin in epilepsies refractory to barbiturates: efficacy, toxicity and mental function. Epilepsy Res 1993;16:147-155.
3. de Bittencourt PRM, Mazer S, Marcourakis T, Bigarella MM, Ferreira ZS, Mumford JP. Vigabatrin: clinical evidence supporting rational polytherapy in management of uncontrolled seizures. Epilepsia 1994;35:373-380.
⁴
Diagnostic and Statistical Manual of Mental Disorders DSM-III-R (Third Edition-Revised) Washington: The American Psychiatric Association, 1987.
5. Dodrill CB. Preoperative criteria for identifying eloquent brain. Intracarotid amytal for language and memory testing. Neurosurg Clin North Am 1993;4:211-215.
6. Engel J Jr. Second Palm Spring Desert Conference on the Surgical Treatment of the Epilepsies (1992). Neurology 1993;43:1612-1617.
7. Engel J Jr. Appendix I. Historical Perspectives. In Engel J Jr (ed). Surgical treatment of the epilepsies, Ed2, New York: Raven Press, 1993;695-705.
8. Engel J Jr. Surgery for seizures. N Engl J Med 1996;334:10;647-652
9. Henriksen O, Larsson PG, Hauglie-Hanssen E, Langmoen Y, Bjornas H. Evaluation of 60 consecutive intracranial recordings. Epilepsia 1993;34:92-98.
10. King D, Spencer S. Invasive electroencephalography in mesial temporal lobe epilepsy. J Gin Neurophysiol 1995;12:32-45.
11. Lorenzo NY, Parisi JE, Cascino GD, Jack CR Jr, Marsh WR, Hirschorn KA. Intractable frontal lobe epilepsy: pathological and MRI features. Epilepsy Res 1995;20:171-178.
12. Ojemann GA et al. Verbal memory deficits after left temporal lobectomy for epilepsy. J Neurosurg 1985;62:101-107.
13. Sandmann MC, Rogacheski E, Mazer S, de Bittencourt PRM. Lateralização da área epileptogênica através de ressonância magnética na epilepsia do lobo temporal. Arq Neuropsiquiatr 1994;52:309-313.
14. Wada J. A new method for the determination of the side of cerebral speech dominance: a preliminary report on the intracarotid injection of sodium amytal in man. Igaku to Seibutsugaki 1945;14:221-222.
15. Wieser HG, Engel J Jr, Williamson PD, Babb TL, Gloor P. Surgically remediable temporal lobe syndromes. In Engel J Jr, Surgical treatment of the epilepsies, Ed2, New York: Raven Press, 1993:49-63.

Publication Dates

Publication in this collection
18 Oct 2010
Date of issue
Sept 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. de Bittencourt PRM. Epileptogênese, estrutura e função cerebral na epilepsia do lobo temporal: um estudo prospectivo controlado. Thesis for the Degree of Professor of Medicine (Neurology) Universidade Federal do Paraná Curitiba, 1991.

[2] 2. de Bittencourt PRM, Antoniuk SA, Bigarella MM, et al. Carbamazepine and phenytoin in epilepsies refractory to barbiturates: efficacy, toxicity and mental function. Epilepsy Res 1993;16:147-155.

[3] 3. de Bittencourt PRM, Mazer S, Marcourakis T, Bigarella MM, Ferreira ZS, Mumford JP. Vigabatrin: clinical evidence supporting rational polytherapy in management of uncontrolled seizures. Epilepsia 1994;35:373-380.

[4] ⁴
Diagnostic and Statistical Manual of Mental Disorders DSM-III-R (Third Edition-Revised) Washington: The American Psychiatric Association, 1987.

[5] 5. Dodrill CB. Preoperative criteria for identifying eloquent brain. Intracarotid amytal for language and memory testing. Neurosurg Clin North Am 1993;4:211-215.

[6] 6. Engel J Jr. Second Palm Spring Desert Conference on the Surgical Treatment of the Epilepsies (1992). Neurology 1993;43:1612-1617.

[7] 7. Engel J Jr. Appendix I. Historical Perspectives. In Engel J Jr (ed). Surgical treatment of the epilepsies, Ed2, New York: Raven Press, 1993;695-705.

[8] 8. Engel J Jr. Surgery for seizures. N Engl J Med 1996;334:10;647-652

[9] 9. Henriksen O, Larsson PG, Hauglie-Hanssen E, Langmoen Y, Bjornas H. Evaluation of 60 consecutive intracranial recordings. Epilepsia 1993;34:92-98.

[10] 10. King D, Spencer S. Invasive electroencephalography in mesial temporal lobe epilepsy. J Gin Neurophysiol 1995;12:32-45.

[11] 11. Lorenzo NY, Parisi JE, Cascino GD, Jack CR Jr, Marsh WR, Hirschorn KA. Intractable frontal lobe epilepsy: pathological and MRI features. Epilepsy Res 1995;20:171-178.

[12] 12. Ojemann GA et al. Verbal memory deficits after left temporal lobectomy for epilepsy. J Neurosurg 1985;62:101-107.

[13] 13. Sandmann MC, Rogacheski E, Mazer S, de Bittencourt PRM. Lateralização da área epileptogênica através de ressonância magnética na epilepsia do lobo temporal. Arq Neuropsiquiatr 1994;52:309-313.

[14] 14. Wada J. A new method for the determination of the side of cerebral speech dominance: a preliminary report on the intracarotid injection of sodium amytal in man. Igaku to Seibutsugaki 1945;14:221-222.

[15] 15. Wieser HG, Engel J Jr, Williamson PD, Babb TL, Gloor P. Surgically remediable temporal lobe syndromes. In Engel J Jr, Surgical treatment of the epilepsies, Ed2, New York: Raven Press, 1993:49-63.