Purpose: To assess the seizure‐freedom rates and self‐perceived psychosocial changes associated with the long‐term outcome of epilepsy surgery in patients with refractory medial temporal lobe ...epilepsy associated with hippocampal sclerosis.
Methods: A standard questionnaire was given to 183 patients who underwent surgery between 1988 and 2004, and 110 were completed.
Results: The mean duration of follow‐up after surgery was 7 years, with a maximum of 17 years. The probability that patients were seizure‐free after surgery was dependent on the definition of the seizure freedom. For the patients who were seizure‐free since surgery (Engel's class Ia), the probability was 97.6% at 1 year after surgery, 85.2% at 2 years after surgery, 59.5% at 5 years after surgery, and 42.6% at 10 years after surgery. For the patients who still experienced rare disabling seizures after surgery but were seizure‐free at least 1 year before the time of assessment, the probability was of 97.6% at 1 year after surgery, 95% at 2 years after surgery, 82.8% at 5 years after surgery, and 71.1% at 10 years after surgery.
The psychosocial long‐term outcome, as measured by indices of driving, employment, familial and social relationships, and marital status, was similar to the psychosocial short‐term outcome. It did not depend on seizure freedom or on follow‐up time interval and was not influenced statistically by seizure frequency in cases of persisting seizures. Most but not all patients noticed a substantial overall improvement in their psychosocial condition; 48% drove (increased by 7%), 47% improved (14% worsened) in their employment status, and 68% improved (5% worsened) in their familial and social relationships. Overall, 91% of patients were satisfied with the surgery, and 92% did not regret their decision.
Conclusions: The results of this study suggest that temporal lobe surgery has real long‐term benefits. Two specific conclusions emerge: (a) the long‐term rates of freedom from seizure depend on how seizure freedom is defined, and (b) the psychosocial long‐term outcome does not change dramatically over years and does not depend on seizure freedom.
In a patient with unilateral hippocampal sclerosis, stimulation of the contralateral anterior perirhinal cortex triggered after-discharges in the sclerotic hippocampus, followed in one case by a ...seizure. The spatial and temporal characteristics of these responses reveal fast interconnections between the two medial temporal lobes.
Pattern reversal, brain stem auditory and somatosensory evoked potentials (PREPs, BAEPs, SEPs) have been recorded on 13 patients occupationally exposed to inorganic lead compounds, in 9 patients ...occupationally or accidentally exposed to inorganic mercury compounds and in 26 chronic alcoholics. The results were compared to those of a normal control group. Peripheral conduction velocities were decreased in lead exposed workers and in alcoholics, but not modified in the mercury exposed patients. In the three exposed groups, an amplitude increase (PREPs and upper limb SEP cortical components), more important in the mercury group and an increase of central conduction time in case of lower limb stimulation, could be interpreted as early signs of nervous cortical impairment.
To obtain objective measures of possible impairment due to organic solvents, auditory, visual and somatosensory evoked potentials and cognitive event related potentials were recorded in a group of 13 ...workers occupationally exposed to a mixture of various solvents. The patients were compared to healthy subjects and to chronic alcoholics seen during post-alcohol withdrawal. Auditory and visual evoked potentials were almost normal but somatosensory evoked potentials showed a slight decrease of peripheral conduction velocities and an increase of central conduction times more marked in the solvent exposed workers who were also alcoholics. The late "cognitive" components reflecting attention processes (N2 and P3) were normal. Solvent-exposed workers and alcoholics were both characterized by some difficulty in modulating their attentional resources according to task demands, as reflected by a tendency to responses (N1, N2 and P3) of similar amplitudes whether the stimulus was or was not the target. These findings support the presence, in solvent exposed workers, of minor dysfunction of the nervous system at both peripheral and cortical levels potentiated by alcohol as well as of mild cognitive impairments concerning attention processes.
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