Journal of Postgraduate Medicine, Education and Research

Register      Login

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


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: 01-12-2018

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


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.

PDF Share
  1. Chang EF, Wang DD, Barkovich AJ, Tihan T, Auguste KI, Sullivan JE, et al. Predictors of seizure freedom after surgery for malformations of cortical development. Annals of neurology. 2011 Jul;70(1):151-162.
  2. Wieser HG. Selective amygdalohippocampectomy: indications and follow-up. Canadian journal of neurological sciences. 1991 Nov;18(S4):617-627.
  3. Berg AT. Defining intractable epilepsy. Advances in neurology. 2006;97:5-10.
  4. Berg AT, Vickrey BG, Testa FM, Levy SR, Shinnar S, DiMario F, et al. How long does it take for epilepsy to become intractable? A prospective investigation. Annals of neurology. 2006 Jul;60(1):73-79.
  5. Wiebe S. Epidemiology of temporal lobe epilepsy. Canadian Journal of Neurological Sciences. 2000 May;27(S1):S6-10.
  6. Wieser HG. Presurgical Evaluation Protocols: University Hospital Zürich in Engel J Jr (ed): Surgical Treatment of the Epilepsies, ed 2. New York: Raven Press, 1993;738-738.
  7. Commission on Classification and Terminology of the International League Against Epilepsy: “Proposal for revised clinical and electroencephalographic classification of epileptic seizures” Epilepsia 1981;22:489-501.
  8. Engel J Jr, Van Ness PC, Rasmussen TB. Outcome with respect to epileptic seizures in Engel J, editor. Surgical treatment of the epilepsies. 2nd ed. New York: Raven Press; 1993;609-21.
  9. Wieser HG. Behavioural consequences of temporal lobe resections in Trimble MR, Bolwig TG (eds): The Temporal Lobes and the Limbic System. Petersfield, UK: Wrightson Biomedical, 1992;169-188.
  10. Wieser HG. Long-term seizure outcomes following Amygdalo- hippocampectomy. J Neurosurg. 2003;98:751-763.
  11. Scheepers M, Kerr M. Epilepsy and behaviour. Current opinion in neurology. 2003 Apr 1;16(2):183-187.
  12. Kim YD, Heo K, Park SC, Huh K, Chang JW, Choi JU, et al. Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy. Epilepsia. 2005 Feb;46(2):251-257.
  13. Bandt SK, Werner N, Dines J, Rashid S, Eisenman LN, Hogan RE et al. Trans-middle temporal gyrus selective amygdalohippocampectomy for medically intractable mesial temporal lobe epilepsy in adults: seizure response rates, complications, and neuropsychological outcomes. Epilepsy Behav. 2013;28(1): 17-21.
  14. Falowski SM, Wallace D, Kanner A, Smith M, Rossi M, Balabanov A, et al. Tailored temporal lobectomy for medically intractable epilepsy: evaluation of pathology and predictors of outcome. Neurosurgery. 2012 Jun 4;71(3):703-709.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.