This report describes the development and successful use of language and memory testing methods for a patient with ocular blindness. Rationale: Blindness in candidates for epilepsy surgery occurs infrequently and there are no published precedents for conducting an intra-carotid amytal (ICA) test in such patients. The bilateral implantation is indicated with caution for the cases with normal MRI, ambiguity in both MRI and ictal EEG, or contradiction between MRI and ictal EEG.ġ Physical medicine and Rehabilitation, University of Utah, Salt Lake City, UT ) Invasive evaluation using bilateral subdural electrodes may be omitted in those cases. For the latter cases, surgery was abandoned in one, and performed in the other after the seizure onset side was determined by the invasive EEG with good outcome (class II).Ĭonclusions: When either MRI or ictal EEG is lateralized and the other modality shows ambiguity, temporal lobe surgery on the side of abnormality may warrant good post-operative outcome. Surgery was performed on the side of MRI abnormality with excellent outcome (class I) in the former case. Among the other 3 cases, contradiction between MRI and ictal EEG was seen in 1, and both MRI and ictal EEG showed ambiguity in 2. In one exceptional case of normal MRI, surgery was performed on the side contralateral to the ictal scalp EEG, resulting in poor outcome (class IV). However, none of them were related to worse outcome. Functional imaging study showed abnormality in the contralateral hemisphere in 4 of those cases. When either MRI or ictal EEG was lateralized and the two findings were not contradictory (n = 14), resection surgery was performed on the side of abnormality except for one case, even when the other modality showed ambiguity, with good post-operative outcome: 10 of 13 (76%) became seizure free.
Results: All the 17 patients were characterized by bilateral interictal spikes on scalp EEG before surgery. Patient database was reviewed to associate pre-operative studies, including MRI, interictal and ictal scalp EEG, and functional imaging such as SPECT, to the side of surgical treatment and post-operative seizure outcome. Methods: This study included 17 consecutive patients with medically intractable temporal lobe epilepsy who underwent implantation of subdural electrodes on the both temporal lobes for pre-surgical evaluation of epilepsy. In this study, we reviewed our surgical cases who had undegone bilateral implantation of subdural electrodes before temporal lobe surgery, in order to define what subgroup of patients could potentially have omitted the invasive evaluation. However, the indication of such procedures, with a certain degree of surgical risks, is not well defined.
In some cases, implantation of subdural or depth electrodes is required on both temporal lobes to define, or confirm, the epileptogenic hemisphere before proceeding to surgical treatment. Rationale: Various degree of bilateral epileptic activity is often found in scalp EEG in temporal lobe epilepsy. Neurosurgery, Kohnan Hospital, Sendai, JapanĢ Neurosurgery, Tohoku University Hospital, Sendai, Japan )
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