Department of Neurology, Seth GS Medical College and KEM Hospital, Mumbai, India.
Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India.
J Postgrad Med. 2024 Apr 1;70(2):97-100. doi: 10.4103/jpgm.jpgm_354_22. Epub 2023 Aug 4.
In the present study patients with previously diagnosed MRI-negative temporal lobe epilepsy (TLE) on long-term video electroencephalography (VEEG) monitoring were re-evaluated with high resolution 3T MRI brain to look out for a skull base temporal lobe encephalocoele (TE). A total of 234 VEEGs were analyzed. TLE had been diagnosed in 104 patients based on semiology, ictal, interictal EEG data, and brain positron emission tomography (PET) studies. Of these, 99 patients had temporal lobe abnormality (78 had mesial temporal sclerosis, 8 had tumor, 3 had focal cortical dysplasia, and 10 had mixed pathology). Out of the five 1.5T MRI-negative TLE patients, two patients were diagnosed with TE on subsequent 3T MRI brain scans and one patient underwent electrocorticography-guided tailored resection for complete removal of epileptogenic tissue; with Engels class I seizure freedom at one year follow-up. We propose that TE should be carefully searched for, as a cause of refractory TLE, using high-resolution MRI sequences.
在本研究中，对经长期视频脑电图（VEEG）监测诊断为先前 MRI 阴性颞叶癫痫（TLE）的患者进行高分辨率 3T MRI 脑检查，以寻找颅底颞叶脑膨出（TE）。共分析了 234 例 VEEG。根据症状学、发作期和发作间期脑电图数据以及脑正电子发射断层扫描（PET）研究，104 例患者被诊断为 TLE。其中，99 例患者存在颞叶异常（78 例存在内侧颞叶硬化，8 例存在肿瘤，3 例存在局灶性皮质发育不良，10 例存在混合性病变）。在 5 例 1.5T MRI 阴性 TLE 患者中，2 例患者在随后的 3T MRI 脑扫描中被诊断为 TE，1 例患者接受了皮质脑电图引导的靶向切除以完全切除致痫性组织；术后 1 年Engels 分级 I 级无癫痫发作。我们建议使用高分辨率 MRI 序列，仔细寻找 TE，因为它可能是难治性 TLE 的病因。
