Samudra Niyatee, Armour Eric, Gonzalez Hernan, Mattingly Danielle, Haas Kevin, Singh Pradumna, Sonmezturk Hasan, Gallagher Martin, Crudele Angela, Nobis William, Reddy Shilpa, Jacobs Monica, Aulino Joseph M, Bick Sarah, Morgan Victoria, Englot Dario, Abou-Khalil Bassel
Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Epilepsy Behav. 2023 Feb;139:109061. doi: 10.1016/j.yebeh.2022.109061. Epub 2022 Dec 30.
To review clinical and neuropsychological characteristics and natural history of a series of patients with temporal lobe epilepsy (TLE) and anterior temporal encephaloceles (ATE) and compare them to a similar series of TLE patients with mesial temporal sclerosis (MTS) to identify characteristics suggestive of ATE-related epilepsy.
Patients with epilepsy and ATE were identified via clinic encounters and consensus epilepsy surgery conference at a Level 4 epilepsy center. The drug-resistant subset of these patients who underwent epilepsy surgery (twenty-two of thirty-five) were compared to age- and laterality-matched patients with MTS. Clinical, neuropsychological, electrophysiologic, and surgical data were abstracted through chart review.
In comparison with MTS, ATE patients were more often female, had significantly later onset of epilepsy, and did not have prior febrile seizures. In addition, ATE patients were more likely to have chronic headaches and other historical features consistent with idiopathic intracranial hypertension (IIH). Failure to identify ATE on initial imaging was common. Most patients had limited temporal cortical resections sparing mesial structures. Of the twenty ATE patients who had a long-term postsurgical follow-up, seventeen (85%) had International League Against Epilepsy (ILAE) Class 1 or 2 outcomes.
A shorter duration of epilepsy, female gender, and lack of history of febrile seizures may suggest ATE as an etiology of refractory TLE in adults. Targeted encephalocele resections can result in seizure freedom, underscoring the importance of encephalocele identification.
回顾一系列颞叶癫痫（TLE）和前颞叶脑膨出（ATE）患者的临床和神经心理学特征及自然病史，并将其与一系列类似的伴有内侧颞叶硬化（MTS）的TLE患者进行比较，以确定提示与ATE相关癫痫的特征。
通过在一家四级癫痫中心的临床会诊和共识癫痫手术会议确定患有癫痫和ATE的患者。将这些接受癫痫手术的耐药患者亚组（35例中的22例）与年龄和病变侧别匹配的MTS患者进行比较。通过病历审查提取临床、神经心理学、电生理和手术数据。
与MTS相比，ATE患者女性更常见，癫痫发作起始明显更晚，且无既往热性惊厥史。此外，ATE患者更有可能患有慢性头痛及其他与特发性颅内高压（IIH）一致的病史特征。初次影像学检查未能发现ATE很常见。大多数患者对内侧结构进行了有限的颞叶皮质切除术。在20例接受长期术后随访的ATE患者中，17例（85%）达到国际抗癫痫联盟（ILAE）1级或2级结局。
癫痫病程较短、女性及无热性惊厥史可能提示ATE是成人难治性TLE的病因。针对性的脑膨出切除术可实现无癫痫发作，强调了脑膨出识别的重要性。
