Multiple hippocampal transections for intractable hippocampal epilepsy: Seizure outcome.

Authors

Mohamad Z. Koubeissi, George Washington UniversityFollow
Emine Kahriman, University Hospitals Case Medical Center, Cleveland, OH
Philip Fastenau
Christopher Bailey
Jonathan P. Miller, mi1001, University Hospitals Case Medical Center, Cleveland, OHFollow
Tanvir U. Syed, University Hospitals Case Medical Center, Cleveland, OH
Shahram Amina
Charles Munyon
Adriana Tanner
Kristina Karanec
Ingrid Tuxhorn
Hans O. Lüders

Document Type

Journal Article

Publication Date

4-8-2016

Journal

Epilepsy & Behavior

Volume

58

Inclusive Pages

86-90

DOI

10.1016/j.yebeh.2016.03.004

Abstract

PURPOSE: The purpose of this study was to evaluate the seizure outcomes after transverse multiple hippocampal transections (MHTs) in 13 patients with intractable TLE.

METHODS: Thirteen patients with normal memory scores, including 8 with nonlesional hippocampi on MRI, had temporal lobe epilepsy (TLE) necessitating depth electrode implantation. After confirming hippocampal seizure onset, they underwent MHT. Intraoperative monitoring was done with 5-6 hippocampal electrodes spaced at approximately 1-cm intervals and spike counting for 5-8min before each cut. The number of transections ranged between 4 and 7. Neuropsychological assessment was completed preoperatively and postoperatively for all patients and will be reported separately.

RESULTS: Duration of epilepsy ranged between 5 and 55years. There were no complications. Intraoperatively, MHT resulted in marked spike reduction (p=0.003, paired t-test). Ten patients (77%) are seizure-free (average follow-up was 33months, range 20-65months) without medication changes. One of the 3 patients with persistent seizures had an MRI revealing incomplete transections, another had an additional neocortical seizure focus (as suggested by pure aphasic seizures), and the third had only 2 seizures in 4years, one of which occurred during antiseizure medication withdrawal. Verbal and visual memory outcomes will be reported separately. Right and left hippocampal volumes were not different preoperatively (n=12, p=0.64, Wilcoxon signed-rank test), but the transected hippocampal volume decreased postoperatively (p=0.0173).

CONCLUSIONS: Multiple hippocampal transections provide an effective intervention and a safe alternative to temporal lobectomy in patients with hippocampal epilepsy.

APA Citation

Koubeissi, M. Z., Kahriman, E., Fastenau, P., Bailey, C., Miller, J. P., Syed, T. U., Amina, S., Munyon, C., Tanner, A., Karanec, K., Tuxhorn, I., & Lüders, H. O. (2016). Multiple hippocampal transections for intractable hippocampal epilepsy: Seizure outcome.. Epilepsy & Behavior, 58 (). http://dx.doi.org/10.1016/j.yebeh.2016.03.004

Peer Reviewed

1