Surgery for Radiologically Normal-Appearing Temporal Lobe Epilepsy in a Centre With Limited Resources

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Surgery for Radiologically Normal-Appearing Temporal Lobe Epilepsy in a Centre With Limited Resources

JournalScientific reports
Publication date – May – 2020
Authors – Muhamad Thohar Arifin, Yuriz Bakhtiar, Erie B P S Andar, Happy Kurnia B, Dody Priambada, Ajid Risdianto, Gunadi Kusnarto, Krisna Tsaniadi, Jacob Bunyamin, Ryosuke Hanaya, Kazunori Arita, Aris Catur Bintoro, Koji Iida, Kaoru Kurisu, Rofat Askoro, Surya P Briliantika, Zainal Muttaqin
Keywordsepilepsy surgery
Open access – Yes
SpecialityNeurosurgery
World region South-eastern Asia
Country: Indonesia
Language – English
Submitted to the One Surgery Index on May 26, 2020 at 5:25 am
Abstract:

Approximately 26-30% of temporal lobe epilepsy (TLE) cases display a normal-appearing magnetic resonance image (MRI) leading to difficulty in determining the epileptogenic focus. This causes challenges in surgical management, especially in countries with limited resources. The medical records of 154 patients with normal-appearing MRI TLE who underwent epilepsy surgery between July 1999 and July 2019 in our epilepsy centre in Indonesia were examined. The primary outcome was the Engel classification of seizures. Anterior temporal lobectomy was performed in 85.1% of the 154 patients, followed by selective amygdalo-hippocampectomy and resection surgery. Of 82 patients (53.2%), Engel Class I result was reported in 69.5% and Class II in 25.6%. The median seizure-free period was 13 (95% CI,12.550-13.450) years, while the seizure-free rate at 5 and 12 years follow-up was 96.3% and 69.0%, respectively. Patients with a sensory aura had better seizure-free outcome 15 (11.575-18.425) years. Anterior temporal lobectomy and selective amygdala-hippocampectomy gave the same favourable outcome. Despite the challenges of surgical procedures for normal MRI TLE, our outcome has been favourable. This study suggests that epilepsy surgery in normal MRI TLE can be performed in centres with limited resources.

OSI Number – 20410
PMID – 32424296

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