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Brain magnetic resonance imaging (MRI), subtracted ictal-interictal SPECT co-registered with MRI (SISCOM) and brain fludeoxyglucose positron emission tomography (FDG-PET) images. Case 1: Brain MRI reveals cortical tubers located at right anterior temporal pole and right middle frontal gyri, and superior frontal gyri (A-1). SISCOM reveals right temporal pole and anterior temporal region hyperperfusion (A-2). Brain FDG-PET reveals right whole temporal lobe hypometabolism (A-3), more involving mesial cortex. Case 2: Brain MRI reveals right hippocampal high signal changes (B-1). SISCOM reveals right temporal cortex hyperperfusion (more on mesial region)(B-2) and brain FDG-PET shows right temporal lobe hypometabolism, more decreased in mesial and basal regions.
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Tuberous sclerosis complex (TSC) is an autosomal dominant disorder. Epileptic seizure is the most common neurological symptom. Medically intractable epilepsy in these patients is candidates of epilepsy surgery. We report two cases of TSC with ictal electroencephalography (EEG) arising from right temporal lobe who underwent video-EEG monitoring. Two...
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Objective: The temporal lobe is a complex part of the brain which contains eloquent structures that perform many higher cerebral functions. Several pathologies can affect the temporal lobes and have different clinical presentations. Temporal lobe surgery includes several approaches with varying outcome results. The aim of this study was to identify...
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... Furthermore, there was no significant difference in the percentage of postoperative seizure freedom between the 1-, 5-, and 10-year followups the outcome between their patients and patients who were multi-staged [18,19]. In addition, advance noninvasive techniques, such as magnetic source imaging and FDG-PET/MRI co-registration, ictal-interictal SPECT co-registered with MRI (SISOM), and diffusive tension imaging, have been applied in a proportion of patients with TSC and intractable epilepsy, whose seizures could not be localized with the standard preoperative evaluations, and 67% of TSC patients with those examinations became seizure free after operation which was comparable to that from patients with invasive EEG recording of ictal onsets [22][23][24]. It was debated whether these patients with TSC, who had been treated with addition noninvasive tests, would also have their seizures localized with intracranial recording [23]. ...
Approximately 50% of patients with tuberous sclerosis complex (TSC) present intractable epilepsy, and surgery is an option for those patients. Hereby, we analyze long-term seizure control and neuropsychological outcomes of epilepsy surgery in patients with TSC. Clinical data were retrospectively collected from 66 patients with TSC and epilepsy followed up over 5 years, 51 of whom underwent epilepsy surgery between 2001 and 2011. Reductions in the number of seizures were analyzed at 1-year (1FU), 5-year (5FU), and 10-year (10FU) follow-ups visits after the operation. Influential factors on postoperative seizure free and intelligence quotient (IQ) and quality-of-life (QOL) outcomes were evaluated at 5FU. Resective procedures included 26 tuber resections, 15 lobectomies, and 10 tuber resections and lobectomies. Corpus callosotomies were performed as the adjunctive approach in 11 cases with low IQ. The percentages of seizure-free cases were 74.5% at 1FU, 58.8% at 5FU, and 47.8% at 10FU, and the predictive factor for long-term postoperative seizure freedom was the history of preoperative seizures and preoperative full-scale IQ. Significant improvements were found in performance IQ, full-scale IQ, and QOL in patients from the surgery group, particularly those who were seizure free after the operation. Our study showed that epilepsy surgery in TSC with epilepsy rendered improvements in seizure control, full-scale IQ, and QOL. Satisfactory long-term seizure control was often achieved with an early operation and without mental retardation, and improvements in QOL and IQ were frequently observed in postoperative patients who remained seizure free.
