Epileptogenic Zones  in Intractable Epilepsy Patients with Dysembryoplastic neuroepithelial tumor

J Korean Neurol Assoc > Volume 16(4); 1998 > Article

Journal of the Korean Neurological Association 1998;16(4): 486-493.

Dysembryoplastic neuroepithelial tumor로 인한 난치성 간질 환자들에서의 간질 병소

성균관대학 의과대학 삼성서울병원

Epileptogenic Zones in Intractable Epilepsy Patients with Dysembryoplastic neuroepithelial tumor

Department of Neurology, Sung Kyun Kwan University, College of Medicine, Samsung Medical Center.

Abstract

Backgrounds: A dysembryoplastic neuroepithelial tumor (DNT) is an important cause of the intractable epilepsy. The prognosis after epileptic surgery was excellent when the epileptogenic zones were completely excised. But, the exact epileptogenic zones in epilepsy patients with DNT are not well known. The purpose of this study was to investigate where the epileptogenic zones were in epilepsy patients with DNT. That results might be helpful in having good results of epileptic surgery of DNT.
Methods: Six patients with medically determined intractable epilepsy due to DNT were studied retrospectively. They had undergone epileptic surgery after video-EEG monitoring not only with scalp electrodes but also with invasive subdural electrodes. DNTs were located in the temporal lobe and pathologically proven in all patients. We analyzed distributions of ictal onset zones and irritative zones with non-invasive and invasive Video-EEG monitoring. Also, we reviewed the clinical features, neuroimaging features, neuropsychological tests, Wada tests and pathological findings. The operative strategy included complete resection of DNT, ictal onset and irritative zones in all patients. In two patients, modified operative strategy including amygdalohippocampectomy was done due to mesial involvement. A modified Engel’s classification was used to determine surgical outcomes.
Results: The irritative zones (included only more than 10% of total interictal discharges during the monitoring) showed various patterns from multifocal to unobserved. Ictal onset zones were multiple in 5 patients (dual: 3 patients, triple: 2 patients). In 1 patient, contralateral hemispheric mirror focus was observed. Mesial temporal involvement was seen in 2 patients from EEG and in 1 patient from pathology. There were discrepancies between ictal onset zones and irritative zones in 4 patients. The EEG seizures without clinical events were recorded in 1 patient. Postoperatively 5 patients were free of seizure, 1 patient had rare seizures.
Conclusion: Not only the wide or multiple distribution of epileptogenic zones around or in the lesion but also dual pathology of hippocampus are possible in epilepsy patients with DNT. The operative strategy including the epileptogenic zones can yield a good surgical outcome. Keywords: Dysembryoplastic neuroepithelial tumor, epileptic surgery, invasive EEG, epileptogenic zones, ictal onset zone, irritative zone