Hana Malikova MD, Presenter: Nothing to Disclose

Lenka Kramska, Abstract Co-Author: Nothing to Disclose

Zdenek Vojtech MD, Abstract Co-Author: Nothing to Disclose

Roman Liscak PhD, Abstract Co-Author: Nothing to Disclose

Temporal lobe epilepsy is the most frequent type of focal epilepsy in adults. Most cases originate from mesial temporal structures (MTLE). Hippocampal sclerosis is a common substrate detected by MRI in MTLE. MTLE is surgically amenable diagnosis, only approximately 25-30% of MTLE patients respond to antiepileptic drugs. However, temporal lobe surgery bears the risk of the decline of neuropsychological functions. Stereotactic radiofrequency amygdalohippocampectomy (SAHE) represents a new alternative to open surgery approaches. This study brings seizure and neuropsychological outcomes and compared neuropsychological results with MRI volumetry of the residual hippocampus.

We included 35 patients with drug-resistant MTLE treated by SAHE. MRI volumetry and neuropsychological examinations were performed before and 1 year after SAHE, clinical seizure outcome was assessed each year after SAHE.

Two years after SAHE, 76% of subjects were seizure free (Engel Class I), 15% of patients suffered from rare seizure (Engel II) and in 9% of patients treatment failed. The hippocampal volume reduction was 58±17% on the left and 54±27% on the right treated side. One year after SAHE the intelligence quotients of treated patients increased. Patients showed slightly significant improvement in verbal memory (VeMQ) (p=0.039) and semantic long-term memory subtest (LTM) (p=0.003). Patients treated on the right side improved in VeMQ, delayed recall and LTM. No changes in memory were found in patients treated on the left side. There was a trend between the larger extent of the hippocampal reduction and the improvement in visual memory (ViMQ) in speech-side operated (p=0.057).

SAHE causes only partial destruction of the hippocampus (figure), but seizure outcome is comparable with open surgery and moreover SAHE does not cause neuropsychological deficits. We found only a trend between the extent of hippocampal reduction and the improvement in ViMQ in speech-side operated.

SAHE is a minimally invasive method for the treatment of MTLE with comparable clinical results with open surgery approaches.

Malikova, H, Kramska, L, Vojtech, Z, Liscak, R, Stereotactic Radiofrequency Amygdalohippocampectomy for the Treatment of Temporal Lobe Epilepsy: Do Good Neuropsychological and Seizure Outcomes Correlate with Hippocampal Volume Reduction?.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12030327.html