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VOLUME 53 , ISSUE 1 ( January-March, 2019 ) > List of Articles

ORIGINAL ARTICLE

Effect of Extent of Hippocampal and Amygdala Resection on Seizure Outcome in Patients with Refractory Epilepsy Secondary to Medial Temporal Sclerosis

Sachin Bindal, Navneet Singla, Parampreet Singh, Manish Modi, Kokkula Praneeth, Manju Mohanty, Sameer Vyas, Sunil K Gupta

Keywords : Hippocampal resection, Medial temporal sclerosis, Refractory epilepsy

Citation Information : Bindal S, Singla N, Singh P, Modi M, Praneeth K, Mohanty M, Vyas S, Gupta SK. Effect of Extent of Hippocampal and Amygdala Resection on Seizure Outcome in Patients with Refractory Epilepsy Secondary to Medial Temporal Sclerosis. J Postgrad Med Edu Res 2019; 53 (1):11-16.

DOI: 10.5005/jp-journals-10028-1305

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

ABSTRACT Introduction: Anterior temporal lobectomy with amygdalohippocampectomy is the most common surgical procedure for refractory epilepsy secondary to mesial temporal sclerosis. There is no consensus on whether the degree of hippocampal or amygdala resection has any influence on determining outcomes after epilepsy surgery. In this study, we assessed the seizure control and neuropsychological outcome and correlated these with the degree of surgical resection as determined on postoperative magnetic resonance imaging (MRI) in patients who had undergone surgery for refractory temporal lobe epilepsy. Materials and methods: A total of 20 patients of refractory medial temporal lobe epilepsy were taken who underwent anterior temporal lobectomy with hippocampal and amygdala resection. Pre and Post-op clinical and neuropsychological assessment was done. Pre- and post-operative MR scans were compared for degree of hippocampal and amygdala resection. Seizure control was assessed based upon the degree of resection. Results: Out of 18 patients with complete resection of the hippocampal body, 17 (94.4%) patients had Engels class I outcome and one (5.6%) patient had Engels class II outcome. But in patients with partial body resection, both the patients (100%) had Engel's class II outcome. On complete resection of the tail, 12 patients had class I and one patient had class II outcome. When the tail of hippocampus was partially resected, or unresected resection five patients had class I but two patients had class II outcome. Conclusion: It is required to achieve complete removal of pes hippocampus and hippocampal body for better seizure control and improvement in neuropsychological performance. The degree of the hippocampal tail or amygdala resection does not affect the outcome.


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