Arslan Gokce Ayhan, Tezer F Irsel, Parlak Safak, Yavuz Ozlem Ozkale, Bilginer Burcak, Soylemezoglu Fıgen, Oguz Kader K, Saygi Serap
Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Turkey.
Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Turkey.
Epilepsy Res. 2021 Jul;173:106640. doi: 10.1016/j.eplepsyres.2021.106640. Epub 2021 Apr 20.
Temporal encephaloceles (TEs) are one of the cause of refractory temporal lobe epilepsy (TLE). We reviewed the neuroimaging and video-electroencephalography (EEG) records of epilepsy patients who underwent temporal lobectomy in our center to investigate frequency of TEs. We retrospectively reevaluated 294 patients who underwent epilepsy surgery in our tertiary epilepsy centre between January 2010 and March 2019 and included 159 patients (78 females, 49 %; 81 males) who had temporal lobectomy. Preoperatively, TEs were reported in 3 of 159 patients (1 female, 2 males). After reevaluation 4 more patients with TEs (1 female, 3 males) were added. The ratio of TE in patients who underwent temporal lobectomy increased from 1.8 % (n=3) to 4,4 % (n=7). The median ages were 18 (range 16-22) versus 10 years (range 5-17) at habitual seizure onset and the median of epilepsy duration was 5 (range 3-15) versus 175 (range 11-25) years between patients with and without TE. Habitual seizure onset age was significantly higher (p =, 007) in the patients with encephalocele and epilepsy duration was shorter (p =, 003) than patients without encephalocele. The ictal EEG records of all patients TE rhythmic delta activity which is suggested neocortical temporal lobe onset seizures. 4 of 7 patients' PET imaging showed temporal lobe hypometabolism compatible with ipsilateral to the TEs. The three patients underwent anterior temporal lobectomy without amygdalohippocampectomy and others had anterior temporal lobectomy with amygdalohippocampectomy. We suggested that there might be some clues for temporal encephalocele, an easily overlooked cause in patients with nonlesional temporal lobe epilepsy.TLE patients with TE had relatively late onset of epilepsy and rhythmic delta activity on ictal EEG. Also, temporal hypometabolism on PET may be a useful key to suspicion of TE.
颞叶脑膨出（TEs）是难治性颞叶癫痫（TLE）的病因之一。我们回顾了在我们中心接受颞叶切除术的癫痫患者的神经影像学和视频脑电图（EEG）记录，以调查TEs的发生率。我们对2010年1月至2019年3月期间在我们的三级癫痫中心接受癫痫手术的294例患者进行了回顾性重新评估，其中包括159例行颞叶切除术的患者（78例女性，占49%；81例男性）。术前，159例患者中有3例（1例女性，2例男性）报告有TEs。重新评估后，又增加了4例有TEs的患者（1例女性，3例男性）。接受颞叶切除术的患者中TEs的比例从1.8%（n = 3）增加到4.4%（n = 7）。有TEs和无TEs的患者习惯性癫痫发作开始时的中位年龄分别为18岁（范围16 - 22岁）和10岁（范围5 - 17岁），癫痫持续时间的中位数分别为5年（范围3 - 15年）和175年（范围11 - 25年）。有脑膨出的患者习惯性癫痫发作开始年龄显著更高（p = 0.007），癫痫持续时间比无脑膨出的患者更短（p = 0.003）。所有有TEs患者的发作期EEG记录均显示有节律的δ活动，提示新皮质颞叶起始的癫痫发作。7例患者中有4例的PET成像显示颞叶低代谢，与TEs同侧相符。3例患者接受了无前颞叶杏仁核海马切除术的前颞叶切除术，其他患者接受了有前颞叶杏仁核海马切除术的前颞叶切除术。我们认为，对于颞叶脑膨出这一在非病变性颞叶癫痫患者中容易被忽视的病因，可能存在一些线索。有TEs的TLE患者癫痫发作开始相对较晚，发作期EEG有节律的δ活动。此外，PET上的颞叶低代谢可能是怀疑TEs的有用关键线索。
