Epilepsy with anterior temporal encephaloceles: Baseline characteristics, post-surgical outcomes, and comparison to mesial temporal sclerosis

• Published in: Epilepsy & behavior 2023-02, Vol.139, p.109061-109061, Article 109061
• Main Authors: Samudra, Niyatee, Armour, Eric, Gonzalez, Hernan, Mattingly, Danielle, Haas, Kevin, Singh, Pradumna, Sonmezturk, Hasan, Gallagher, Martin, Crudele, Angela, Nobis, William, Reddy, Shilpa, Jacobs, Monica, Aulino, Joseph M., Bick, Sarah, Morgan, Victoria, Englot, Dario, Abou-Khalil, Bassel
• Format: Article
• Language: English
• Subjects: Adult; Encephalocele; Encephalocele - complications; Encephalocele - diagnostic imaging; Epilepsy, Temporal Lobe - complications; Epilepsy, Temporal Lobe - diagnostic imaging; Epilepsy, Temporal Lobe - surgery; Female; Hippocampal Sclerosis; Humans; Magnetic Resonance Imaging; Male; Medication-resistant epilepsy; Mesial temporal sclerosis; Retrospective Studies; Sclerosis - complications; Seizures, Febrile - complications; Temporal lobe epilepsy; Treatment Outcome
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2022.109061

•Temporal encephalocele identification permits targeted successful epilepsy surgery.•We clinically compared temporal encephalocele to mesial temporal sclerosis patients.•Later age at onset, female gender, and no febrile seizure history suggested temporal encephalocele. To review clinical and neuropsychological characteristics and natural history of a series of patients with temporal lobe epilepsy (TLE) and anterior temporal encephaloceles (ATE) and compare them to a similar series of TLE patients with mesial temporal sclerosis (MTS) to identify characteristics suggestive of ATE-related epilepsy. Patients with epilepsy and ATE were identified via clinic encounters and consensus epilepsy surgery conference at a Level 4 epilepsy center. The drug-resistant subset of these patients who underwent epilepsy surgery (twenty-two of thirty-five) were compared to age- and laterality-matched patients with MTS. Clinical, neuropsychological, electrophysiologic, and surgical data were abstracted through chart review. In comparison with MTS, ATE patients were more often female, had significantly later onset of epilepsy, and did not have prior febrile seizures. In addition, ATE patients were more likely to have chronic headaches and other historical features consistent with idiopathic intracranial hypertension (IIH). Failure to identify ATE on initial imaging was common. Most patients had limited temporal cortical resections sparing mesial structures. Of the twenty ATE patients who had a long-term postsurgical follow-up, seventeen (85%) had International League Against Epilepsy (ILAE) Class 1 or 2 outcomes. A shorter duration of epilepsy, female gender, and lack of history of febrile seizures may suggest ATE as an etiology of refractory TLE in adults. Targeted encephalocele resections can result in seizure freedom, underscoring the importance of encephalocele identification.