Subjective and methods between april 2011 and december 20, a total of 30 patients having partial seizures with or without secondary generalization were selected from the neurology department, sayed galal hospital. Structural damage in tle associated with hs is a condition that characterizes mesial. The diagnosis of temporal lobe epilepsy was established clinically on the basis of the course of the seizure. Unfortunately, no one i had seen before had read the right textbooks i guess. The specialized protocol includes quantitative volumetry and t2 relaxometry, mrs. High resolution magnetic resonance imaging mri of the brain can identify macroscopic tp fcd in the preoperative evaluation for epilepsy surgery. Most brain mri scans do not include coronal images, but for temporal lobe epilepsy this sequence is more informative than are the axial and sagittal cuts.
The automatisms of mediobasal temporal lobe epilepsy are typically less violent than in frontal lobe seizures, and are usually oroalimentary lipsmacking, chewing, swallowing, or gestural e. In this article, we explore the expanding role of mri in the diagnosis and management of patients with temporal lobe epilepsy. T1 tse coronal oblique 2mm epilepsy protocol plan the coronal high resolution slices on the sagittal plane. Temporal lobe epilepsy due to brain tumor misdiagnosis. An appropriate angle must be given in the axial plane perpendicular to mid line of the brain. Mr imaging of temporal lobe epilepsy sciencedirect. Temporal lobe epilepsy tle is the most common type of partial epilepsy, with often characteristic imaging and clinical findings. Diffusion weighted images dwi are included in our routine temporal epilepsy protocol, which may provide information in the periictal phase in patients with. Temporal lobe epilepsy tle is the most common form of partial related refractory. Evidence from previous volumetric magnetic resonance studies has revealed that patients with chronic temporal lobe epilepsy show atrophy of distinct subcortical nuclei, predominantly ipsilateral to the focus side. The onset of temporallobe epilepsy extended back to the first decade of life in 21 patients and to the second decade in 16 of the patients.
An mri showed a brain tumor the size of a plum behind my right eye. A, an axial noncontrastenhanced computed tomographic scan of the bone window shows a complex fracture of the right occipital bone and temporal bone, and mastoid air cells extending into the right side of the cavity. This pdf document has been automatically generated from a digital poster. An invaluable resource for anyone touched by epilepsy, seized gives firsthand accounts of three ordinary patients with temporal lobe epilepsy tle, explaining what they suffer and how they cope. Aug 31, 2015 lateralization of temporal lobe epilepsy tle is critical for successful outcome of surgery to relieve seizures. Secondary generalisation is much less common than in extratemporal lobe epilepsy.
Enhanced magnetic resonance imaging of a rat model of temporal lobe epilepsy by mansi b. Clinical, eeg, and mri differences in frontal and temporal. The authors discuss the classifications available and examine how adequate they are for defining the subtleties of behavioral changes in patients with neurological disorders. Computed tomography, epilepsy, magnetic resonance imaging. Although the majority of epilepsy centers require ictal recordings for all surgical candidates 71, some centers perform surgery on a subset of subjects without requiring longterm. Numerous studies of patients with temporal lobe epilepsy have demonstrated that magnetic. Mri protocol for epilepsy is a group of mri sequences put together to improve sensitivity and specificity in identifying possible structural abnormalities that underlie seizure disorders e. Patients who had contralateral or extratemporal epileptiform. Threedimensional spoiled grass 3dspgr sequences provided 2mm contiguous sections of the limbic system, enabling assessment of the hippocampus hc, fornix fn and. Esclerosis mesial temporal pdf in most patients, the epileptogenic focus involves the structures of the mesial temporal lobe illustrated in the diagrams below. The accuracy of visual assessment of hippocampal asymmetry was compared with volumetric measurements. On the other hand, patients with temporal lobe epilepsy and normal mri have received less attention.
Cortical thickness in left temporal lobe epilepsy jason lerch, neda bernasconi, andrea bernasconi, alan c. We were interested to find out if there is also selective subcortical atrophy in patients suffering from long standing extratemporal lobe epilepsy. The requirement for ictal eeg recordings prior to temporal. Efficacy of temporal lobe surgery for epilepsy in patients with negative mri for. Medical sciences neuroscience structural changes in limbic regions are often observed in individuals with temporal lobe epilepsy tle and in animal models of tle. Temporal lobe epilepsy tle is one of the most frequent forms of refractory partial epilepsies. In order to demonstrate the absence of a potentially epileptogenic structural lesion, it is critical that patients have highresolution seizure protocol mri with both t 1 and t 2weighted images jack, 1996. Hippocampal atrophy appears to correspond to the duration of seizure disorder.
Temporallappenepilepsie, lasionslo kalisation, funktionelle konnektivitat, netzwerkeffekt introduction it has been known since the work of ramon y cajal 18521934 that the brain is basically a vast, dynamic. Magnetic resonance imagine mri is the essential tool for the diagnosis and evaluation of epileptic patients due to the possibility of it identifying the epileptogenic substrate and the decisive value for the selection of surgical candidates in cases of refractory epilepsy. Its efficacy in comparison to medical treatment for intractable epilepsy has not been seriously doubted by many workers and has now been confirmed in a randomized, controlled study of 80 patients, half with ongoing medical treatment versus half subjected to surgery. A colorfully illustrated book about children with disabilities for. Tle affects brain regions beyond the temporal lobes and has been associated with aberrant brain networks, based on evidence from functional magnetic resonance imaging. Mar 07, 2012 temporal lobe epilepsy tle is the commonest form of focal epilepsy and represents almost 23 of cases of intractable epilepsy managed surgically. Improved lesion detection requires both a dedicated epilepsy protocol for mri optimized for lesion detection and the interpreting radiologists familiarity with common causes of epilepsy. Temporal lobe epilepsy tle is the most common form of adult localizationrelated epilepsy.
Mri was performed in 222 consecutive adult patients with temporal lobe epilepsy of varying severity from january 1991 to may 1993. However, the limited resolution of current clinical protocols still precludes a. When an mri shows hippocampal sclerosis in the medial temporal lobe and eegs show seizures starting in that same area, seizures may be. The clinical diagnosis of tle was made according to the criteria of the international league against epilepsy. Health, general magnetic resonance imaging comparative analysis medical research medicine, experimental temporal lobe epilepsy. Slices must be sufficient to cover the whole brain. Introduction this paper describes the anatomic features of the temporal lobe which are important in the most commonly performed surgical approaches for. Lateralization of temporal lobe epilepsy tle is critical for successful outcome of surgery to relieve seizures. Clinical seizures recorded during veeg were classified as cps versus complex partial with secondary generalization. The diagnosis of hippocampal sclerosis was established visually by three independent observers. Mri each patient underwent brain mri with an epilepsy tailored protocol at either 1. For practical purposes, focal epilepsy can be divided into mesial temporallobe epilepsy mtle and neocortical epilepsy. Living with temporal lobe epilepsy is the story of one womans journey down the rabbit hole and into the wonderland of temporal lobe epilepsy. We performed mri on 27 patients with clinically proven temporal lobe epilepsy tle, all with prior eeg lateralisation, and 10 volunteers, studied to evaluate disparity in size arising from biological variation group 1.
Lateralizing value of interictal spikes on overnight sleep. There were many many warning signs but i fell through the cracks each time. Temporal lobe epilepsy tle is the most common form of focal epilepsy that may secondarily generalize. A 21yearold woman at admission to the trauma center after a motor vehicle accident with loss of consciousness. Temporal lobe epilepsy radiology reference article. Hippocampal onset accounts for at least 80% of all temporal lobe seizures. As mentioned, mri is the neuroimaging modality of choice for patients with temporal lobe epilepsy. Risk reduction in dominant temporal lobe epilepsy surgery. The term temporal lobe epilepsy tle was included in the classification of the ilae in 1989 under the group of localization related symptomatic epilepsies characterized by seizures with sp e. Mri of the fornix and mamillary body in temporal lobe epilepsy. Evans mcconnell brain imaging centre, montreal neurological institute, mcgill university introduction hippocampal atrophy is the most commonly reported mri. Epilepsy surgery outcomes in temporal lobe epilepsy with a. A proper mri investigation of patients with focal epilepsy requires the use of specific protocols, selected based on identification of the region of onset by clinical and eeg findings.
Check the positioning block in the other two planes. As i am sure you are aware, mri has revolutionized the diagnosis and presurgical evaluation of temporal lobe epilepsy. Dec 22, 2017 as mentioned, mri is the neuroimaging modality of choice for patients with temporal lobe epilepsy. The mri protocol during the language tasks was as follows. A history of febrile seizures especially complex febrile seizures is common in tle and is frequently associated with mesial temporal sclerosis the commonest form of tle. Burneo 3, seyed mirsattari 3, david steven 3, andrew g. Histopathology findings in mrinegative focal epilepsy chapter 19. Surgery for extratemporal lobe epilepsy clinical gate. The onset of temporal lobe epilepsy extended back to the first decade of life in 21 patients and to the second decade in 16 of the patients. The advent of high resolution mri with a dedicated epilepsy protocol has. The common causes of epilepsy discernible with imaging are hippocampal sclerosis hs. Amnesia is the rule for the blank spell and the automatism. Anterior temporal lobe abnormality in temporal lobe epilepsy.
Sharon tells of her life starting with the diagnosis and moving through seizurerelated issues, the isolation associated with a condition still carrying a negative stigma, to the. Visual and volumetric analyses of the hippocampal formations of a group of patients with clinical diagnosis of temporal lobe epilepsy abstract. Our aim was to assess and compare between tissuespecific and structural brain atrophy findings in tle to ige patients and to healthy controls hc. It has a variety of causes such as strokes, tumors and malformations. However, to get the full benefit of effective diagnosis with current mri technology requires an optimized temporal lobe imaging protocol and an experienced mri reader. Mri segmentation analysis in temporal lobe and idiopathic. Magnetic resonance imaging and histology correlation in. A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure. Epilepsy represents a multifaceted group of disorders divided into two broad categories, partial and generalized, based on the seizure onset zone. Apr 30, 2020 as i am sure you are aware, mri has revolutionized the diagnosis and presurgical evaluation of temporal lobe epilepsy. Moreover, diffuse atrophy or contralateral hippocampal abnormalities suggested a poor postoperative outcome16. Comparative lateralizing ability of multimodality mri in. The term temporal lobe epilepsy tle was included in the classification of the ilae in. However, the most common cause of tle in surgical series is hippocampal sclerosis hs, which can reliably be detected in vivo by mri 2, 3.
Seized is a narrative portrait of a common brain disorder that can alter personality, illuminating the mindbody problem and the limits of free will. Patients often complain of poor memory for recent events, and this may get worse as the epilepsy continues. Epilepsy classi cation, eeg analysis, and eegfmri fusion. Temporal lobe epilepsy tle is the commonest form of focal epilepsy and represents almost 23 of cases of intractable epilepsy managed surgically. The identification of the neuroanatomic site of seizure onset depends on delineation of seizure semiology by a careful history together with videoeeg, and a variety of neuroimaging technologies such as mri, fmri, fdgpet, meg, or invasive. Mri brain epilepsy protocol and planning indications for. Patients with extratemporal lobe epilepsy do not differ. Routine brain mri protocols are inappropriate for the study of. About onethird of patients with tle may become resistant to medical therapy and require surgical treatment. Explains epilepsy in a reassuring way for newly diagnosed children, their siblings and friends. Temporal lobe epilepsy tle and idiopathic generalized epilepsy ige patients have each been associated with extensive brain atrophy findings, yet to date there are no reports of head to head comparison of both patient groups.
Khan 1,5 1 imaging research laboratories, robarts research institute, 2 biomedical engineering graduate program. We present here a machine learningbased method for determining the laterality of tle, using features extracted. Surgery for temporal lobe epilepsy tle is widely practiced in the developed world. Both conventional and more advanced mri techniques are capable of exploring a range of physiological phenomena not available in other imaging modalities, and thus provide valuable insight into the pathophysiology underlying temporal lobe epilepsy.
The diagnosis of temporallobe epilepsy was established clinically. For patients who had mesial temporal lobe epilepsy and disabling seizures for no more than 2 consecutive years following adequate trials of 2 brandname aeds, engel et al found that resective surgery plus aed treatment resulted in a lower probability of seizures. Temporal lobectomy is the definitive treatment for medically intractable temporal lobe epilepsy, as it has a high seizurefree rate. In dominant temporal lobe epilepsy surgery, speech, memory. Quantitative mri assessment of the hippocampus assessment of hippocampal atrophy can be improved by measuring hippocampal volumes. Secondary generalisation is much less common than in extra temporal lobe epilepsy. Unfortunately, no one i had seen before had read the right text books i guess. Threedimensional spoiled grass 3dspgr sequences provided 2mm contiguous sections of the limbic system, enabling assessment of the hippocampus hc, fornix fn.
Epilepsy mesial temporal lobe sclerosis disorders of development epileptogenic. Comparative lateralizing ability of multimodality mri in temporal lobe epilepsy. Temporal lobe epilepsy tle is a chronic disorder of the nervous system characterized by recurrent, unprovoked focal seizures that originate in the temporal lobe of the brain and last about one or two minutes. Tle is the most common form of epilepsy with focal seizures. Frontiers lateralization of temporal lobe epilepsy based. Abstract children who underwent videoeeg monitoring between 1995 and 2000, and were classified as frontal lobe epilepsy fle n39 or mesial temporal lobe epilepsy mtle n17, were examined for clinical, eeg, and quantitative mri differences, in a study at sydney childrens hospital, australia. Patient type number of patients nes 32 ltle 39 rtle 34 btle 14 utle 5 pet and mri images were acquired according to the best clinical practices at. A coronal t2weighted 3t mri section shows reduced hippocampal. Expert reports of epilepsy dedicated mri protocols further. Mri is the imaging procedure of choice for epilepsy investigation, especially 3 tesla mri. The purpose of this study was to evaluate the role of magnetic resonance spectroscopy mrs in nonlesional temporal lobe epilepsy. Magnetic resonance imaging mri of the brain spares a. A three plane localiser must be taken in the beginning to localise and plan the sequences.
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