Elsevier

Epilepsy Research

Volume 11, Issue 1, March 1992, Pages 51-59
Epilepsy Research

Research report
MRI in the presurgical evaluation of patients with frontal lobe epilepsy and children with temporal lobe epilepsy: pathologic correlation and prognostic importance

https://doi.org/10.1016/0920-1211(92)90021-KGet rights and content

Abstract

We performed magnetic resonance imaging (MRI) using a high-field strength magnet (1.5 T) in two series of 53 patients with intractable partial epilepsy of frontal lobe or temporal lobe origin who subsequently received ablative surgery for their seizure disorder. In the first series of patients the pathologic correlation and prognostic importance of an MRI-identified lesion in the frontal lobe were assessed. Twenty-five percent of the patients with negative MRI studies and 67% of patients with neuroimaging abnormalities restricted to the frontal lobe, were seizure-free at a minimum duration of follow-up of 1 year. None of the patients with a multilobar MRI-detected abnormality was seizure-free postoperatively. In the second study the sensitivity and specificity of MRI-based hippocampal volumetry was determined in pediatric patients with partial epilepsy of temporal lobe origin unrelated to foreign-tissue pathology. Hippocampal formation atrophy in the epileptic temporal lobe was identified in 63% of patients. The sensitivity and specificity of hippocampal volumetry was 100% in patients with mesial temporal sclerosis. The presence of an MRI-detected epileptogenic lesion in the frontal lobe and hippocampal formation atrophy in the temporal lobe may correlate with the underlying pathology and affect the identification of potential candidates for epilepsy surgery.

References (31)

  • G.D. Cascino et al.

    Stereotactic resection of intra-axial cerebral lesions in partial epilepsy

  • M. Hajek et al.

    Extratemporal, mainly frontal, epilepsies: surgical results

    J. Epilepsy

    (1988)
  • D.D. Armstrong et al.

    Postscript: what terminology is appropriate for tissue pathology? How does it predict outcome?

  • T.L. Babb et al.

    Pathological findings in epilepsy

  • E.M. Bebin et al.

    Tuberectomy and hamartectomy for intractable seizures in tuberous sclerosis

    Ann. Neurol.

    (1990)
  • D. Bergen et al.

    Magnetic resonance imaging as a sensitive and specific predictor of neoplasms removed for intractable epilepsy

    Epilepsia

    (1989)
  • T.P. Bleck et al.

    Neuropathologic analysis of tissue excised during corticographically guided seizure focus resection

    Epilepsia

    (1985)
  • G.D. Cascino et al.

    Magnetic resonance imaging-based volume studies in temporal lobe epilepsy: pathological correlations

    Ann. Neurol.

    (1991)
  • A.V. Delgado-Escueta et al.

    Complex partial seizures of frontal lobe origin

  • F.E. Dreifuss

    Goals of surgery for epilepsy

  • J. Engel

    Alternative therapy

  • P. Gloor

    Commentary: approaches to localization of the epileptogenic lesion

  • R.J. Gumnit

    Postscript: who should be referred for surgery?

  • C.R. Jack et al.

    Anterior temporal lobes and hippocampal formations: normative volumetric measurements from MR images in young adults

    Radiology

    (1989)
  • C.R. Jack et al.

    Temporal lobe seizures: lateralization with MR volume measurements of the hippocampal formation

    Radiology

    (1990)
  • Cited by (152)

    • Thin isotropic FLAIR MR images at 1.5T increase the yield of focal cortical dysplasia transmantle sign detection in frontal lobe epilepsy

      2017, Epilepsy Research
      Citation Excerpt :

      It is the structural MRI lesions in combination with acute and chronic neurophysiological findings by means of ECoG that formulate the surgical resection boundaries and determine the fulfillment of the “completeness” requirement for optimal post-surgical outcome (Palmini et al., 1991; Ferrier et al., 2001; Wagner et al., 2011). The transmantle sign is the MR imaging hallmark of FCD type II and a predictor of successful post-operative outcomes regarding seizure control (Cascino et al., 1992; Barkovich et al., 1997; Urbach et al., 2002; Wang et al., 2013). However imperative structural lesion determination is for successive epilepsy surgery in FLE, in suspected frontal FCD epilepsy patients transmantle sign identification percentages are generally lower than anticipated by means of 1.5T MR scans (Madan and Grant, 2009).

    View all citing articles on Scopus

    Part of this material was presented at the American Epilepsy Society, San Siego, CA, November, 1990 and at the forty-third annual meeting of the American Academy of Neurology, Boston, MA, April, 1991.

    View full text