The Postoperative Follow-up Study Of Intractable Epilepsy And The Investigation Of Pathology About Cortex Of Temporal Lobe In Temporal Lobe Epilepsy (TLE) With Hippocampal Sclerosis

Section oneThe clinical effectiveness of multioperation and the prognosisfactors analysis in intractable epilepticObjective To study the clinical effectiveness of multioperation in intractableepileptic with the help of MRI,FLAIR ,PET, three-dimensional epileptogenic focilocalization and treatment planning system. To analysis the relationship between theoperation effectiveness and the prognosis factors including sex, inducement, the typeof seizure, presymptom, the position of epileptic focus, the extent of epileptic focus,predilection time, age, the first seizure age, course of disease, the persistence time ofseizure, seizure frequency, the total operation time, the Intracalvarium operation time,the volume of blood loss.Methods The clinical informations, the operation programs and the operationeffectiveness of 359 patients with intractable epilepsy were analyzed retrospectivelyfrom September 1999 to September 2005. 359 cases with intractable epilepsy, male 233 cases, female 126 cases, age from 3 to 50 years old, average 22.09 years old. Allcases accepted the examination of MRI and three-dimensional epileptogenic focilocalization and treatment planning system to ascertain the location and scope ofepileptic focus. 268 cases accepted the examination of FLAIR and 68 cases acceptedthe examination of PET among 359 cases. All cases were treated with operation.Epileptic focus were thoroughly treated if the functions were not influenced. Themethods of operation included anterior temporal lobectomy, corticectomy outside oftemporal, partial anterior callosotomy or partial anterior latent callosotomy, multiplesubpial transection and multiple subpial fan-shaped transection, thermocoagulation incortex, lysis of adhesions. The anti-epileptic drugs were adjusted after operation. Allcases were treated with anti-epileptic drugs until today. Follow up were accomplishedby readmission, out-patient re-examination and call. All the data were statisted withSPSS 10.0 statistical software package.Results The follow-up of over 1 year postoperatively found up that Satisfactoryrate in this study was 94.15%. By single factor analysis, outcome was significantlyassociated with inducement, the type of seizure, presymptom, the position of epilepticfocus, the extent of epileptic focus, predilection time, the first seizure age, course ofdisease, seizure frequency. On the other hand, no significant differences were foundregarding sex, age, the persistence time of seizure, the total operation time, theIntracalvarium operation time and the volume of blood loss. By multivariate logisticregression analysis, inducement, generalized seizures, seizure in sleep, the longercourse of disease were independent risk factors.Conclusion The proper operation is safe and effective to intractable epilepticwith the help of three-dimensional epileptogenic foci localization and treatmentplanning system. The epileptics with the prognosis factors including no inducement,partial seizures, no presymptom, the temporal lobe epilepsy, single lobe epilepsyusually obtain more favorable outcome. The epileptics with the prognosis factorsincluding seizure most in sleep, the low first seizure age, the long course of disease,the high seizure frequency usually obtain unfavorable outcome. The epileptics of thetemporal lobe epilepsy, single lobe epilepsy, children epilepsy should become the emphasises in epilepsy surgery and all intractable epileptics should accept the surgerytreatment in time.Section twoInvestigation of pathology of cortex of temporal lobe about temporal lobeepilepsy (TLE) with hippocampal sclerosisObjective To analyze the pathology appearance of cortex of temporal lobeabout temporal lobe epilepsy (TLE) with hippocampal sclerosis. And to comparewith control group in order to approach whether cortex of temporal lobe plays a partin the occurrence and propagation of TLE with hippocampal sclerosis.Methods Ten cases in experimental group all were finally diagnosed as TLEwith hippocampal sclerosis. Cortex of temporal lobe gathered from experimentalgroup during operation acts as experimental example. Six cases in control group werepatients which also accepted operation in the same department including 2 cases (onewas diagnosed as durosarcoma, the other was diagnosed as cholesteatoma) and 4cases which were diagnosed as cerebral traumae. Six case all never had epilepticseizure. Cortex of temporal lobe gathered from control group during operation acts ascontrol example. The cases in two groups were selected in random.Gamma-aminobutyric acid neurons in all examples were marked by the way ofimmunity histochemistry. To cout the gamma-aminobutyric acid neurons in everyexample by microscope. Then the number from experimental example were camparedwith one from control group. To observe the other pathology appearance of cortex oftemporal lobe about temporal lobe epilepsy (TLE) with hippocampal sclerosis.Results The number in experimental example was fewer than the one incontrol group. And there was significant difference between them. The similarpathology appearance of hippocamp of temporal lobe about TLE with hippocampalsclerosis was found in cortex of temporal lobe of that, such as loss of neuron, degeneration of neuron, astrocytes proliferation, and so on.Conclusions Besides hippocampus, pathological changes of neuron orastrocytes in temporal cortex could be concerned with occurrence and propagation ofTLE with hippocampal sclerosis. Anterior temporal lobectomy maybe more suitableto TLE with hippocampal sclerosis if the patient must accept operation.