Good surgical outcome in discordant ictal EEG-MRI unilateral mesial temporal sclerosis patients

Autor(es)

Castro, Luiz H. ; Serpa, Mauricio H. ; Valério, Rosa M. ; Jorge, Carmen L. ; Ono, Carla R. ; Arantes, Paula R. ; Rosemberg, Sergio ; Wen, Hung Tzu

• Tipo de documento: Artigo Científico
• Fonte: Epilepsia; v. 49, n. 8, p. 1324-1332, Aug. 2008.
• Área do conhecimento: Ciências da Saúde - Medicina
• Assunto(s): Radiologia Eletroencefalografia Tomografia Lobo temporal Doenças do sistema nervoso central Epilepsia

Resumo

Video electroencephalography (vEEG) monitoring of patients with unilateral mesial temporal sclerosis (uMTS) may show concordant or discordant seizure onset in relation to magnetic resonance imaging (MRI) evidence of MTS. Contralateral seizure usually leads to an indication of invasive monitoring. Contralateral seizure onset on invasive monitoring may contraindicate surgery. We evaluated long-term outcome after anteromesial temporal lobectomy (AMTL) in a consecutive series of uMTS patients with concordant and discordant vEEG findings, uniformly submitted to AMTL on the MRI evidence of MTS side without invasive monitoring. We compared surgical outcome of all uMTS patients undergoing vEEG monitoring between January 1999 and April 2005 in our service. Discordant cases were defined by at least one seizure onset contralateral to the MRI evidence of MTS. Good surgical outcome was considered as Engel's class I. We also evaluated ictal SPECT concordance to ictal EEG and surgical outcome. Fifty-four patients had concordant (C) and 22 had discordant (D) scalp EEG and MRI. Surgical outcome was similar in both groups (C = 74% versus D = 86%). Duration of follow-up was comparable in both groups: C = 56.1 ± 20.7 months versus D = 59.8 ± 21.2 months (p = 0.83, nonsignificant). Discordant single-photon emission computed tomography (SPECT) results did not influence surgical outcome. Surgical outcome was not influenced by contralateral vEEG seizure onset or contralateral increased flow on ictal SPECT. Although vEEG monitoring should still be performed in these patients, to rule out psychogenic seizures and extratemporal seizure onset, a potentially risky procedure such as invasive monitoring may not only not be indicated in this patient population, but may also lead to patients erroneously being denied surgery. (AU)

• Processo FAPESP: 05/50067-8 - Epilepsia do lobo temporal associada a esclerose de hipocampo: avaliação do impacto do acometimento bilateral de estruturas temporais mesiais no resultado cirúrgico, medidas através de exames estruturais e funcionais pré-operatórios
• Beneficiário: Maurício Henriques Serpa
• Modalidade de apoio: Bolsas no Brasil - Iniciação Científica
• Processo FAPESP: 05/56464-9 - Centro de Imagem em Neurociências da Faculdade de Medicina da Universidade de São Paulo
• Beneficiário: Giovanni Guido Cerri
• Modalidade de apoio: Auxílio à Pesquisa - Programa CINAPCE - Temático