Faculty Collaboration Database

Clinical characteristics and surgical outcomes of epilepsy associated with temporal encephalocele: A systematic review. Epilepsy Behav 2024 Sep;158:109928

Date

07/04/2024

Pubmed ID

38959747

DOI

10.1016/j.yebeh.2024.109928

Scopus ID

2-s2.0-85197059735 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

Temporal encephaloceles (TE) are an under-identified, potentially intervenable cause of epilepsy. This systematic review consolidates the current data to identify the major clinical, neuroimaging, and EEG features and surgical outcomes of epilepsy associated with TE. Literature searches were carried out using MEDLINE, Embase, PsycINFO, Scopus, and Cochrane Library databases from inception to December 7, 2023. Studies were included if they described clinical, neuroimaging, EEG, or surgical data in ≥5 patients with TE and epilepsy. Of 562 studies identified in the search, 24 met the eligibility criteria, reporting 423 unique patients with both epilepsy and TE. Compared to epilepsy patients without TE, those with TE had a higher mean age of seizure onset and were less likely to have a history of febrile seizures. Seizure semiologies were variable, but primarily mirrored temporal lobe onset patterns. Epilepsy patients with TE had a higher likelihood of having clinical or radiographic features of idiopathic intracranial hypertension (IIH) than those without. Brain MRI may show ipsilateral mesial temporal sclerosis (16 %). CT scans of the skull base usually revealed bony defects near the TE (90 %). Brain PET scans primarily showed ipsilateral temporal lobe hypometabolism (80 %), mostly in the anterior temporal lobe (67 %). Scalp EEG mostly lateralized ipsilateral to the implicated TE (92 % seizure onset) and localized to the temporal lobe (96 %). Intracranial EEG revealed seizure onset near the TE (11 of 12 cases including TE-adjacent electrodes) with variable timing of spread to the ipsilateral hippocampus. After surgical treatment of the TE, the rate of Engel I or ILAE 1 outcomes at one year was 75 % for lesionectomy, 85 % for anterior temporal lobectomy (ATL), and 80 % for ATL with amygdalohippocampectomy. Further studies are needed to better elucidate the relationship between IIH, TE, and epilepsy, improve the identification of TE, and optimize surgical interventions.

Author List

Zhou DJ, Woodson-Smith S, Emmert BE, Kornspun A, Larocque J, Kulick-Soper CV, Qiu MK, Ellis CA, Gugger JJ, Conrad EC, Waldman G, Ganguly T, Sinha SR, Davis KA, Stein JM, Liu GT, Gelfand M, Raghupathi R

Author

Joshua J. Larocque MD Assistant Professor in the Neurology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Electroencephalography
Encephalocele
Epilepsy
Humans
Temporal Lobe
Treatment Outcome