Abstract Details

Title The Role of Hippocampography and Hippocampectomy in Symptomatic Extrahippocampal Temporal Lobe Epilepsy

Topic Epilepsy

Presentation(s) P04 - (-)

Poster/Presentation
Number 197

Objective

Background BACKGROUND: Symptomatic lesions account for a large proportion of temporal lobe epilepsy cases. Not uncommonly these lesions are located outside the hippocampus in temporal neocortex. When epilepsy is medically refractory, the treatment of choice is surgery. Resection may include the mesially located hippocampus, especially if the hippocampal electrocorticogram demonstrates epileptiform abnormalities. However hippocampectomy in the dominant hemisphere entails considerable risk to neuropsychological function, such as memory, in addition to the general hazard of more extensive neurosurgery.

Design/Methods DESIGN/METHODS: In a retrospective chart review, we found 6 patients who underwent hippocampography during surgery to resect an extrahippocampal temporal lobe lesion. We reviewed their hippocampography, radiology, pathology, extents of resection, and Engel scores to classify their degree of seizure freedom.

Results RESULTS: Only one patient with frequent spiking on hippocampal electrocorticography underwent dominant hippocampectomy as part of their lesional epilepsy surgery. The remaining 3 patients with frequent spiking and 2 additional patients with little to no spiking did not undergo hippocampectomy. Seizure control based on Engel score was 2D in the patient whose dominant hippocampus was removed. Engel scores ranged from 1A to 4B in those whose hippocampi remained intact.

Conclusions CONCLUSIONS: Although our numbers are small and retrospective, the variable Engel scores should give one pause when considering dominant hippocampectomy as part of lesional epilepsy surgery in patients with symptomatic temporal lobe epilepsy from an extrahippocampal source.

Authors/Disclosures
Marcus Ng, MD (University of Manitoba) PRESENTER	The institution of Dr. Ng has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Paladin Canada. The institution of Dr. Ng has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Paladin Canada. Dr. Ng has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neurophysiology. The institution of Dr. Ng has received research support from Eisai. The institution of Dr. Ng has received research support from Paladin Canada. Dr. Ng has received publishing royalties from a publication relating to health care.
Ronan Kilbride, MD	No disclosure on file
Mirela V. Simon, MD	Dr. Simon has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Risk Management Foundation of the Harvard Institutions Incorporated. Dr. Simon has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for MCIC Vermont. Dr. Simon has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Aaronson, Rappaport, Feinstein& Deutch. Dr. Simon has received publishing royalties from a publication relating to health care. Dr. Simon has received personal compensation in the range of $0-$499 for serving as a Speaker with American Clinical Neurophysiology Society . Dr. Simon has a non-compensated relationship as a Speaker with International Society of Intraoperative Neurophysiology that is relevant to AAN interests or activities. Dr. Simon has a non-compensated relationship as a Speaker with Brazilian Congress of Neurology that is relevant to AAN interests or activities.
	No disclosure on file
Andrew Cole, MD, FAAN (Massachusetts General Hospital)	Dr. Cole has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Cole has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ANA. Dr. Cole has received publishing royalties from a publication relating to health care.
Aksel Siva, MD (Istanbul University Cerrahpasa School of Medicine)	Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen - TR. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ali Raif Pharmaceuticals, Turkiye. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanovel Pharmaceuticals, Turkiye. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abdi Ibrahim Ilac - TR. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono . The institution of Dr. Siva has received research support from Turkish MS Society. The institution of Dr. Siva has received research support from The Scientific and Technological Research Council Of Turkey - Health Sciences Research Grants.

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