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Less than 3% of temporal lobe epilepsy (TLE) surgical outcome studies have investigated the psychiatric sequelae and morbidity associated with surgery. This is disproportionate to the extent of the problem. Variable prevalence rates have been reported for post-surgical depression, anxiety, and interictal psychosis. Until recently, very few studies distinguished de novo postoperative presentations from pre-existing conditions, making it difficult to accurately assess the impact of TLE surgery on psychiatric morbidity. Predictors of de novo postoperative presentations have proved elusive. This current review summarizes the findings from a systematic literature review of the psychiatric morbidity associated with TLE surgery including newly published follow-up data from our own series of 280 surgical patients. A framework for future research, possible pathophysiological mechanisms, and translational models are also discussed.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

BACKGROUND: Temporal lobe epilepsy (TLE) is a recurrent chronic nervous system disease. The conventional treatment is medicine. So far, anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH) are becoming the two main approaches.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

There seems to be a role for serotoninergic neuro-transmission in the pathophysiology of the epilepsies. Different groups have studied the role of regulatory variants in the SLC6A4 gene, which code for the central serotonin transporter, in the complex genetics of temporal lobe epilepsy (TLE) obtaining contradictory findings. Therefore, a systematic review and critical analysis of this topic seem to be timely. Published studies up to October 2011 of TLE and the SLC6A4 promoter and intron 2 variant number repeat polymorphisms (VNTR) were identified by searches of Medline, Scopus and ISI-Web of Sciences databases. Meta-analysis of TLE case-control data were performed to assess the association of SLC6A4 VNTRs with TLE susceptibility. Pooled odds ratios were estimated by means of a genetic-model-free approach. The quality of the included studies was assessed by a score. The studies included compared a total of 991 TLE cases and 1,202 controls. We did not find synthetic evidence of association between SLC6A4 promoter and intron 2 variants and the risk of TLE. However, the intron 2 VNTR seems to have opposite effects in different populations. In this meta-analysis our findings were inconclusive in order to associate any of the 5-HT receptor gene variants with the risk of TLE.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

OBJECTIVES: Many patients thought to have temporal lobe epilepsy, are evaluated for surgical treatment. Decision-making in epilepsy surgery is a multidisciplinary, phased process involving complex diagnostic tests. This study reviews the literature on the value of different tests to decide on whether to operate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

OBJECT: Whether selective amygdalohippocampectomy (SelAH) has similar seizure outcomes and better neuropsychological outcomes compared with anterior temporal lobectomy (ATL) is a matter of debate. The aim of this study was to compare the 2 types of surgery with respect to seizure outcomes and changes in IQ scores.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

OBJECTIVE: To assess the predictive diagnostic added value of positron emission tomography (PET) in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy (TLE).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Epilepsy is a neurological condition characterised by involuntary activity of the brain, which manifests in seizures. The rate of epilepsy in people with intellectual diabilities is significantly higher than in the general population. Epilepsy in this population is often less responsive to antiepileptic drugs (AEDs) and is associated with higher rates of morbidity and mortality. One relevant study comparing two surgical procedures has been included in this review. This study found that anterior corpus callosotomy (a procedure in which a section of the corpus callosum is severed) with anterior temporal lobectomy (a procedure in which part of the temporal lobe is removed) is more effective than anterior temporal lobectomy alone in improving quality of life and performance on IQ tests among people with epilepsy and intellectual disabilities. No support was found for a relative benefit of either procedure for improved seizure control. This review accentuates the lack of randomised controlled trials (RCTs) evaluating non‐pharmacological interventions for people with epilepsy and intellectual disabilities. Given the prevalence and nature of epilepsy in this population, well‐designed RCTs are needed to ascertain the effects of non‐pharmacological interventions on seizure and behavioural outcomes in people with intellectual disabilities. However, good quality evidence derived from RCTs including the non‐intellectually disabled should be assessed for side effects and efficacy before such studies are undertaken.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 10, 2015

Despite many antiepileptic drugs being available, about 30% of epilepsy patients are not seizure‐free. Electrical stimulation through implanted electrodes in contact with the brain (i.e. intracranial electrical stimulation, referring to 'deep brain stimulation' and 'cortical brain stimulation') has been proposed as an alternative treatment for these patients. This review aimed to evaluate its efficacy, safety and tolerability.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 18, 2017

Focal epilepsies are caused by abnormal electrical discharges in specific (localised) parts of the brain. In most people the resulting epileptic seizures can be controlled with medication. In up to 30% of people these seizures are not controlled by medication. If the site of origin of these signals (the epileptogenic zone) can be located from the description of the seizures, or from magnetic resonance imaging (MRI) (a medical imaging scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body) and electroencephalography (EEG) findings (recording of electrical activity along the scalp) the person should be offered the chance of having the epileptogenic zone removed. We studied the factors (characteristics of the people undergoing surgery and details of surgery type) that might be linked to the best chance of surgical cure of epileptic seizures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 1, 2015

We explored the association between magnetic resonance imaging (MRI) lesion, degree of seizure laterality on intracranial electroencephalography (iEEG), and seizure outcome in patients with ambiguous or presumed bilateral temporal lobe epilepsy (BiTLE) on scalp EEG. We systematically reviewed the literature using Embase and MEDLINE up to May 31, 2012. Patients with bilateral iEEG, temporal lobe surgery, and follow-up ≥1 year were included. We undertook three separate analyses on patients whose scalp EEG showed ambiguous onset or BiTLE (1) group data of those whose iEEG demonstrated unilateral TLE, (2) group data of those whose iEEG demonstrated BiTLE, (3) individual patient analysis in those with BiTLE for whom iEEG seizure laterality data were provided. Of 1,403 patients with ambiguous or presumed BiTLE on scalp EEG, 1,027 (73%) proved to have unilateral TLE on iEEG and contributed to the first analysis. Of these, 58% had Engel class I and 9% Engel class II outcomes. Of 132 patients in the second analysis (true BiTLE), Engel class I and II outcomes were achieved in 23% and 14%, respectively. Of 41 patients in the third analysis, 66% and 2% had Engel class I and II outcomes, respectively. The median proportion of seizures ipsilateral to the resection on iEEG did not differ between BiTLE patients with Engel class I-II (76%) and Engel III-IV (78%) outcomes (p = 0.87). Patients with ambiguous or independent bitemporal seizure onset on scalp EEG achieved good surgical outcomes. Overall, a significantly higher proportion of patients achieved good outcomes when iEEG showed unilateral TLE (67%) than when it showed true BiTLE (45%). However, the degree of seizure lateralization in those with BiTLE was not associated with seizure outcome, and it has a limited role in selecting the side of surgery.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

BACKGROUND: Approximately 50-100% of patients with temporal lobe epilepsy undergoing anterior temporal lobe resection (ATLR) will suffer a postoperative visual field defect (VFD) due to disruption of the optic radiation (OpR).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center examining the comparative efficacy, safety, and tolerability of newer versus older and innovator versus generic antiepileptic medications.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: December 2011

This guideline is a partial update of ‘The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care’ (NICE clinical guideline 20, 2004). It updates the pharmacological management sections of the 2004 guideline and also includes the use of the ketogenic diet.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: January 2012

Epilepsy is the commonest serious neurological condition with a lifetime cumulative incidence of 2-3%. Although for the majority of people with epilepsy the outlook for seizure control is good, between 20 and 30% will continue to have seizures despite ongoing treatment with antiepileptic drugs (AEDs). Of these, the majority have a symptomatic or cryptogenic localisation-related epilepsy, which for some may be successfully treated with surgical resection of the focus (epilepsy surgery). The prime aim of epilepsy surgery is to remove the seizure focus and hence bring about seizure freedom without causing other disability.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2006

AIM: To describe the general aspects of cavernomas and epilepsy and review the available literature on the utility of electrocorticography (ECoG) in cerebral cavernoma surgery.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

The neuroimaging results of drug-resistant epilepsy patients play an important role in the surgery decision and prognosis. The aim of this study was to evaluate the impact of these results on the efficacy of epilepay surgery, and then to explore surgical benefit for epilepsy patients with negative magnetic resonance (MR) images. Twenty-four subgroups describing the outcomes of 1475 epilepsy patients with positive-neuroimaging results and 696 patients with negative-neuroimaging results were involved in the meta-analysis. Overall, the odds of postoperational seizure-free rate were 2.03 times higher in magnetic resonance imaging-positive (MRI-positive) patients than in MRI-negative patients [odds ratio (OR)=2.03, 95% CI (1.67, 2.47), P<0.00001]. For patients with temporal lobe epilepsy (TLE), the odds were 1.76 times higher in those with MRI-positive results than in those with MRI-negative results [OR=1.76, 95% CI (1.34, 2.32), P<0.0001]. For patients with extra-temporal lobe epilepsy (extra-TLE), the odds were 2.88 times higher in MRI-positive patients than in MRI-negative patients [OR=2.88, 95% CI (1.53, 5.43), P=0.001]. It was concluded that the seizure-free rate of MRI-positive patients after surgery was higher than that of MRI-negative patients. For patients with negative results, an appropriate surgery should be concerned for TLE.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

This review assessed the effectiveness and cost-effectiveness of neuroimaging, to visualise the seizure focus, for patients with refractory epilepsy, who were being considered for surgery. The included studies were limited, with insufficient evidence to assess the imaging techniques to inform clinical practice.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

This review found that magnetic resonance spectroscopy showing an abnormality on the same side as the epileptogenic zone has a good association with outcome following surgery. The review suffers from a number of methodological limitations, therefore these findings should be interpreted with extreme caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

The review concluded that epilepsy surgery was associated with specific cognitive changes, but may also improve cognition in some patients. Given the possibility of bias, limited and variable evidence of unknown quality and major methodological shortcomings in the review, the authors' conclusions should be treated with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

This review assessed the risk of seizure recurrence after the planned discontinuation of antiepileptic drugs (AEDs) following surgery for epilepsy. The authors concluded that one in three patients were at risk of seizure recurrence after discontinuing AEDs. The results were based on potentially biased retrospective studies, and the authors' conclusions do not adequately reflect the limitations of this evidence.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

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