Publication: Residual hippocampal and parahippocampal volume post anterior temporal lobectomy and seizure control in temporal lobe epilepsy
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Date
2021
Authors
Kwang, Julian Tan Li
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Abstract
Background: Temporal lobe epilepsy (TLE) is the most common cause of epilepsy. Hippocampal sclerosis (HS) is the primary cause of TLE and the most frequent histopathological diagnosis encountered during epilepsy surgery in adults, accounting for approximately 45 percent of all surgical cases. To date, there is no data in Malaysia comparing postoperative volumetric MRI findings with seizure control. Hospital Sungai Buloh is one of the facilities that performs epilepsy surgery in Malaysia, making it an ideal site for data collection. Objective: This study aims to determine whether more extensive surgery on the hippocampus correlates with better epilepsy control. Methods: This is a cross-sectional study utilizing data from the electronic medical record system at Hospital Sungai Buloh, known as the "Electronic Healthcare Information System" (eHIS). Data were obtained from patients diagnosed with "mesial temporal sclerosis" (MTS) who underwent an "anterior temporal lobectomy and amygdalohippocampectomy" (ATL+AH) between 2014 and 2020. Patients classified as Engel Class I were categorized as having "good control," while those in Engel Classes II–IV were categorized as having "poor control." MRI images were imported into the ITK-SNAP software to perform volumetric calculations. These findings were then compared against the patients' seizure control outcomes. A p-value of <0.05 was considered statistically significant. Results: A total of 40 patients were included in this study. Among them, 72.5% of the cohort achieved freedom from epilepsy. A smaller hippocampal volume was associated with better seizure control (176.9 mm³ versus 364.8 mm³, p = 0.014). All seven patients with an epilepsy duration of less than 12 years achieved good post-surgical control (Engel Class I), though this was not statistically significant (p = 0.159). No correlations were found regarding gender, laterality, age at onset, age at surgery, EEG findings, or the presence of risk factors in relation to epilepsy control. Conclusion: There is statistical evidence that the extent of resection—or the volume of residual tissue—is associated with post-surgical epilepsy control. Therefore, the surgical removal of a sufficient portion of the hippocampus is the most significant predictor of seizure control. Nevertheless, further studies are required to evaluate long-term outcomes.
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