PURPOSE: Memory complaints are common in patients with epilepsy, particularly temporal lobe epilepsy. Many factors may adversely affect memory function in epilepsy, including seizures themselves, pathology causing the epilepsy and antiepileptic medication. The Wechsler Memory Scale (WMS) is used widely for test of memory. The aim of this study is to evaluate memory in patients with temporal lobe epilepsy using the WMS and to analyze memory impairment with respect to various factors. METHODS: Twenty four epileptic patients with temporal lobe epilepsy were evaluated with the WMS. Memory impairment was analyzed with respect to age at seizure onset, epilepsy duration, and antiepileptic medication. RESULTS: Memory test using the WMS showed significant differences between epileptic patients and controls for general information, mental control, associate learning, digit span and logical memory subtests. There was no correlation between memory quotient and age at seizure onset, epilepsy duration, or antiepileptic medication. CONCLUSIONS: Patients with temporal lobe epilepsy have a memory impairment though none of the factors to impair memory function in epileptic patients could be identified.
Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Learning ; Logic ; Memory* ; Pathology ; Seizures ; Temporal Lobe*

BACKGROUND: Quantitative measurement of hippocampal T2 relaxation time is an objective means of determining the frequency and severity of signal abnormalities. To evaluate the diagnostic properties of T2 relaxometry in temporal lobe epilepsy(TLE), we measured T2 relaxation time of bilateral hippocampi in pathology-proven TLE patients and normal controls. METHODS: We investigated 10 TLE patients who had temporal lobectomy with MR T2 relaxation mapping. All patients underwent in phase I or II studies, and had pathologic diagnosis. Also we measured T2 relaxation time in 10 normal volunteers. RESULTS: The pathologic findings of 10 TLE patients were followings: 8 hippocampal sclerosis (including dual pathology of necrotic granuloma), 1 calcified fibrous nodule, and 1 normal hippocampus. The mean T2 relaxation time of normal controls is 67.5msec, which is lower value than previous reports. All patients with hippocampal sclerosis in pathology showed increased T2 time greater than 2 SD of mean value of normal controls. But, the T2 values are upper normal range in non-hippocampal sclerosis. The lateralizing value of T2 relaxometry is 50% in TLE patients, and 62.5% in pathology-proven hippocampal sclerosis groups. CONCLUSIONS: There is a clear distinction of T2 relaxation time between the patients of hippocampal sclerosis and normal controls or non-hippocampal sclerosis. These findings suggest that the T2 relaxation time is a reliable objective measurement of hippocampal pathology, especially hippocampal sclerosis in TLE.
Diagnosis ; Epilepsy, Temporal Lobe* ; Healthy Volunteers ; Hippocampus ; Humans ; Pathology ; Reference Values ; Relaxation ; Sclerosis ; Temporal Lobe*

OBJECTIVE: The aim of this study is to compare the frequency of postoperative epilepsies of patients with chronic as opposed to recent onset epilepsy due to glial tumors in the frontal or temporal lobe with the hypothesis that patients with chronic epilepsy do worse. METHODS: We compared the clinical and diagnostic characteristics of the patients(n=73) who had seizures preoperatively to those of the patients(n=153) who did not. Among those who have had seizures preoperatively, we compared those(n=32, chronic seizure group) who had seizures a year or more prior to surgery to those(n=41, acute seizure group) who had seizures within a year prior to surgery. RESULTS: Among the various factors, the frequency of benign pathology and favorable neurological state were higher in seizure group than in non-seizure group(p<0.05). Complex partial seizure and low-grade tumors were frequent in chronic seizure group, whereas simple partial seizure and high-grade tumors were frequent in acute seizure group. Seizure-free rate was significantly higher in acute seizure group than in chronic one(p<0.05). Also, the difference of seizure control rate between surgical strategies were statistically significant(p<0.05). CONCLUSION: This study indicates that preoperative seizure durations and frequencies have a close relationship with the frequency of postoperative epilepsy of glial tumors. A longer lapse may allow the formation of epileptogenic foci, leading to chronic epilepsy, and eventually having a negative effect on the prognosis of the patients. Factors including histopathological characteristics of the tumor, its location, seizure duration/frequency, and semiology should be taken account of deciding on surgical strategies.
Brain Neoplasms ; Epilepsy* ; Glioma ; Humans ; Pathology ; Prognosis ; Seizures ; Temporal Lobe

PURPOSE: To compare the diagnostic value of electroencephalography (EEG), MRI and PET studies and surgical outcome in patients with medically refractory temporal lobe epilepsy due to hippocampal sclerosis (HS) versus temporal lobe lesions (TLL). METHODS: Records of 122 consecutive patients who underwent surgery for epilepsy from January 1993 to April 2000 were retrieved from the MGH Epilepsy Surgery Database. Fifty eight patients with temporal lobe epilepsy due to pathologically proven HS or TLL were identified and presurgical interictal and ictal EEG, MRI, and 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG)-PET data and surgical outcome were reviewed. Patients with dual or normal pathology were excluded. Pathologically proven HS was present in 32 patients, and 26 patients has temporal lobe lesions (cortical dysplasia in 6 patients, vascular malformation in 6, gliomas in 5, DNET in 4, heterotopia in 1, other pathologies in 4). Comparisons of the diagnostic value of EEG, MRI and FDG-PET studies were performed in 43 patients who were seizure-free after epilepsy surgery. Among 43 patients, HS was in 24 patients and TLL in 19. RESULTS: The occurrence of abnormal interictal and ictal EEG, MRI and FDG-PET findings in the side of operation was not significantly different between patients with HS and with TLL respectively. There was no significant difference in at least one year follow-up surgical outcome between the two groups. CONCLUSIONS: Diagnostic value of presurgical interictal and ictal EEG, MRI and FDG-PET findings, and surgical outcome were not different in patients with mesial versus neocortical temporal lobe epilepsies.
Electroencephalography* ; Epilepsy ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Glioma ; Humans ; Magnetic Resonance Imaging ; Neuroimaging* ; Pathology ; Sclerosis ; Temporal Lobe* ; Vascular Malformations

BACKGROUND: The typical MRI features of hippocampal sclerosis (HS) are volume loss and increased T2 weighted signal intensity. Hippocampal volumetry and T2 relaxometry are useful quantitative methods for presurgical diagnosis of HS, especially in the cases of mild, bilateral or focal hippocampal atrophies. We investigated the value of a new quantitative method using FLAIR (Fluid Attenuated Inversion Recovery) MR images compared to those of visual inter-pretation and MR volumetry. METHODS: Forty-five patients with mesial temporal lobe epilepsy (TLE) and 21 under-went volumetric MRI (T1-weighted, SPGR, T2 weighted, and FLAIR images). All patients underwent anterior temporal lobectomy with amygdalohippocampectomy., where visual analysis and hippocampal volumetry were performed. The absolute and normalized values of hippocampal FLAIR signal intensity [hippocampal FLAIR intensity/superior frontal FLAIR intensity=Hippocampal-Frontal Signal Intensity Ratio (HFSR)] were obtained from both normal subjects and patients with TLE. RESULTS: The pathology of resected hippocampus showed HS in all patients. Visual interpretation of presurgical MRI failed to lateralize HS in 10 patients (22.2%). Among these 10 patients, the HS was lateralized by HFSR method in seven patients (70%) [Five (50%) by right-to-left difference of HFSR and the other two (20%) by analysis of a longitudinal regional curve of HFSR] while it was further lateralized by hippocampal volumetry in only three. CONCLUSIONS: In presurgical evaluation of patients with TLE, the hippocampal FLAIR signal analysis appeared to be complementary to visual interpretation and MR volumetry.
Anterior Temporal Lobectomy ; Atrophy ; Diagnosis ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Pathology ; Sclerosis ; Temporal Lobe*

BACKGROUND: Patients with neocortical temporal lobe epilepsy(NTLE) are reported to have less favorable outcome with anterior temporal lobectomy, and the prognostic factors for patients with non-lesional NTLE are not well defined. METHODS: We analyzed the multiple potential predictors of outcome for 26 consecutive medically intractable non-lesional NTLE patients who have had both extracranial and intracranial EEG monitoring during their presurgical evaluation prior to surgery: age, age at seizure onset, sex, seizure semiology, seizure duration and frequency, an etiology, the site of the surgery, the region of intracranial ictal onset, intracranial amobarbital procedure, neuropsychology test, neuroimaging, multiple subpial transection(MST) and surgical pathology. The average follow up period was 37.0+/-11.1(range 20-60) months. The outcome factors analyzed were compared to two types of outcome group; seizure free group(class I) and persistent seizure group(class II-IV) according to Engel's classification. RESULTS: Seventeen of 26 non-lesional NTLE patients(65.4%) were seizure free during follow up. Intracranial ictal onset confined to anterior temporal region only significantly predicted seizure free(p<0.001). Earlier seizure onset(p=0.08) and resection without MST(p=0.10) tended to be seizure free, but not statistically significant. CONCLUSION: Patients with non-lesional NTLE can be a good candidate for a tailored anterior temporal neocorticectomy with/without MST after intracranial EEG monitoring and functional mapping.
Amobarbital ; Anterior Temporal Lobectomy ; Classification ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Neuroimaging ; Neuropsychology ; Pathology, Surgical ; Seizures ; Temporal Lobe*

BACKGROUND: Mesial temporal sclerosis (MTS) is a well-known cause of temporal lobe epilepsy. Coexistence with cortical dysplasia (CD) has been reported, but its role is not well recognized. This study aims to determine whether there is any difference about clinical feature and surgical outcome between patients with MTS and coexistent CD (group 1) and patients with isolated MTS (group 2). METHODS: Retrospectively, surgical series of 45 patients (male:22, female:23) diagnosed as temporal lobe epilepsy were reviewed. We excluded patients who had another pathology (e. g., tumor, vascular malformation) except MTS or CD. The pathology, case histories, interictal EEG, and surgical outcome were compared. RESULTS: There was a tendency for group 1 patients to have earlier seizure onset age (10.9+/-6.35 versus 14.5+/-6.03, p=0.06) There was no statistically significant difference in the history of febrile convulsions (68.4% versus 53.8%, p>0.16) No statistically significant difference between groups were also found in disease duration, the head trauma/mental retardation history, seizure frequency, interictal EEG, and surgical outcome. CONCLUSIONS: CD in MTS appears to have an influence on seizure onset. The relationships among CD, febrile convulsion, and mesial temporal sclerosis must be more investigated.
Age of Onset ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Head ; Humans ; Malformations of Cortical Development* ; Pathology* ; Retrospective Studies ; Sclerosis* ; Seizures ; Seizures, Febrile ; Temporal Lobe*

BACKGROUND: Mesial temporal sclerosis (MTS) is a well-known cause of temporal lobe epilepsy. Coexistence with cortical dysplasia (CD) has been reported, but its role is not well recognized. This study aims to determine whether there is any difference about clinical feature and surgical outcome between patients with MTS and coexistent CD (group 1) and patients with isolated MTS (group 2). METHODS: Retrospectively, surgical series of 45 patients (male:22, female:23) diagnosed as temporal lobe epilepsy were reviewed. We excluded patients who had another pathology (e. g., tumor, vascular malformation) except MTS or CD. The pathology, case histories, interictal EEG, and surgical outcome were compared. RESULTS: There was a tendency for group 1 patients to have earlier seizure onset age (10.9+/-6.35 versus 14.5+/-6.03, p=0.06) There was no statistically significant difference in the history of febrile convulsions (68.4% versus 53.8%, p>0.16) No statistically significant difference between groups were also found in disease duration, the head trauma/mental retardation history, seizure frequency, interictal EEG, and surgical outcome. CONCLUSIONS: CD in MTS appears to have an influence on seizure onset. The relationships among CD, febrile convulsion, and mesial temporal sclerosis must be more investigated.
Age of Onset ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Head ; Humans ; Malformations of Cortical Development* ; Pathology* ; Retrospective Studies ; Sclerosis* ; Seizures ; Seizures, Febrile ; Temporal Lobe*

BACKGROUND: In order to improve MRI volumetry of hippocampus, we obtained the Longitudinal Regional Volume Curve (LRVC) of hippocampi and compared the sensitivity of LRVC with those of conventional hippocampal volume-tries (total and regional) in temporal lobe epilepsy (TLE). METHODS: Thirty-eight normal subjects and 24 TLE patients were included in this study. The pathology of all patients showed hippocampal sclerosis. The volume of the hippocampus was measured by a manual tracing in 3 mm-thickness coronal MRI slices perpendicular to the long axis of the hippocampus and a three-dimensional reconstruction. Total volume and regional volumes (anterior, middle, and posterior 1/3) of the right and left hippocampi were measured. Then, the focal hippocampal volume of each of the coronal slices (3 mm) was plotted in a X-Y graph to obtain LRVC. The presence and pattern of HA were determined in LRVC. RESULTS: The mean volume of right hippocampus (2512+/-629 mm3) was bigger than that of the left one (2262.6+/-563.2 mm3) in normal subjects. The normal range of right-left total volume difference was 3.6~495.2 mm3. The sensitivities of conventional volumetry, regional volumetry, and LRVC were 66.7%, 75%, and 83.3%, respectively. Eleven patients showed diffuse HA (11/20, 55.0%) and nine had focal HA (9/20, 45.0%). In focal HA, the middle and posterior HA were more frequent (6/9, 66.7%) than anterior HA. CONCLUSIONS: LRVC improved the sensitivity of MRI volumetry in detecting hippocampal sclerosis and could reveal the pattern (diffuse or focal) of HA. (J Korean Neurol Assoc 19(2):125~131, 2001)
Axis, Cervical Vertebra ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Magnetic Resonance Imaging* ; Pathology ; Reference Values ; Sclerosis* ; Temporal Lobe*

BACKGROUND: In order to improve MRI volumetry of hippocampus, we obtained the Longitudinal Regional Volume Curve (LRVC) of hippocampi and compared the sensitivity of LRVC with those of conventional hippocampal volume-tries (total and regional) in temporal lobe epilepsy (TLE). METHODS: Thirty-eight normal subjects and 24 TLE patients were included in this study. The pathology of all patients showed hippocampal sclerosis. The volume of the hippocampus was measured by a manual tracing in 3 mm-thickness coronal MRI slices perpendicular to the long axis of the hippocampus and a three-dimensional reconstruction. Total volume and regional volumes (anterior, middle, and posterior 1/3) of the right and left hippocampi were measured. Then, the focal hippocampal volume of each of the coronal slices (3 mm) was plotted in a X-Y graph to obtain LRVC. The presence and pattern of HA were determined in LRVC. RESULTS: The mean volume of right hippocampus (2512+/-629 mm3) was bigger than that of the left one (2262.6+/-563.2 mm3) in normal subjects. The normal range of right-left total volume difference was 3.6~495.2 mm3. The sensitivities of conventional volumetry, regional volumetry, and LRVC were 66.7%, 75%, and 83.3%, respectively. Eleven patients showed diffuse HA (11/20, 55.0%) and nine had focal HA (9/20, 45.0%). In focal HA, the middle and posterior HA were more frequent (6/9, 66.7%) than anterior HA. CONCLUSIONS: LRVC improved the sensitivity of MRI volumetry in detecting hippocampal sclerosis and could reveal the pattern (diffuse or focal) of HA. (J Korean Neurol Assoc 19(2):125~131, 2001)
Axis, Cervical Vertebra ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Magnetic Resonance Imaging* ; Pathology ; Reference Values ; Sclerosis* ; Temporal Lobe*