Cerebellar atrophy and prognosis after temporal lobe resection.

OBJECTIVE: Experimental data indicate inhibitory effects of the cerebellum on seizure activity. Structural damage such as cerebellar atrophy, which is a common finding in patients with chronic epilepsy, may reduce these effects. METHODS: Outcome after temporal lobectomy was studied in 78 consecutive patients, with or without cerebellar atrophy diagnosed by MRI. RESULTS: Thirty five patients (45%) showed cerebellar atrophy. At a mean follow up of 14.6 (range, 6-40) months, 50 patients (64%) had no postoperative seizures. In these patients, the frequency of cerebellar atrophy was significantly lower (34%) than in patients who relapsed (64%, p < 0.01). Occurrence of generalised tonic-clonic seizures (GTCS) within two years before surgery, occurrence of GTCS at any time preoperatively, long duration of epilepsy, and older age at surgery were also associated with recurrence of seizures. Multiple logistic regression analysis suggested occurrence of GTCS within two years before surgery and cerebellar atrophy as the main predictive indicators. When both factors were present, the percentage of patients remaining seizure free since surgery fell to 30%, compared with 60% when only GTCS were present, 78.6% when only cerebellar atrophy was present, and 87.5% when both factors were absent. CONCLUSIONS: Cerebellar atrophy shown by MRI was a frequent finding in surgically treated patients with temporal lobe epilepsy. The presence of cerebellar atrophy seems to worsen the prognosis after temporal lobe resection.

[1]  W. Spielmeyer.  Über einige Beziehungen zwischen Ganglienzellveränderungen und gliösen Erscheinungen, besonders am Kleinhirn , 1920 .

[2]  J. Rhoads.  Surgical aspects. , 1950, Delaware medical journal.

[3]  Willibald Scholz.  Die Krampfschädigungen des Gehirns , 1951 .

[4]  R. Snider,et al.  Some Cerebellar Influences on Electrically‐Induced Cerebral Seizures * , 1955, Epilepsia.

[5]  R. Snider,et al.  Cerebello-hippocampal influences on the electroencephalogram. , 1959, Electroencephalography and clinical neurophysiology.

[6]  R. Dow,et al.  The influence of the cerebellum on experimental epilepsy. , 1962, Electroencephalography and clinical neurophysiology.

[7]  T. Rasmussen,et al.  Prognostic factors in the surgical treatment of temporal lobe epileptics , 1968, Neurology.

[8]  M. Dam.  NUMBER OF PURKINJE CELLS IN PATIENTS WITH GRAND‐MAL EPILEPSY TREATED WITH DIPHENYLHYDANTOIN , 1970, Epilepsia.

[9]  M. Dam.  Number of Purkinje Cells in Patients with Grand Mai Epilepsy treated with Diphenylhydantoin , 1970, Acta neurologica Scandinavica.

[10]  J. Frost,et al.  The Influence of the Cerebellum in Cat Penicillin Epilepsy , 1972, Epilepsia.

[11]  B. Meldrum,et al.  Systemic factors and epileptic brain damage. Prolonged seizures in paralyzed, artificially ventilated baboons. , 1973, Archives of neurology.

[12]  W. Mckinney,et al.  Cerebellar degeneration following long‐term phenytoin therapy , 1976, Neurology.

[13]  I. Jensen.  TEMPORAL LOBE EPILEPSY , 1976, Acta neurologica Scandinavica.

[14]  I. Jensen.  Temporal lobe epilepsy: types of seizures, age, and surgical results. , 1976, Acta neurologica Scandinavica.

[15]  I. Gartside.  The effects of cerebellectomy on a penicillin epileptogenic focus in the cerebral cortex of the rat. , 1978, Electroencephalography and clinical neurophysiology.

[16]  A. M. Dam,et al.  Does Seizure Activity Produce Purkinje Cell Loss? , 1984, Epilepsia.

[17]  C. Paz,et al.  Amygdala kindling in totally cerebellectomized cats , 1985, Experimental Neurology.

[18]  H. Henningsen,et al.  [Cerebellar atrophy in epileptic patients: computer tomography study]. , 1985, Fortschritte der Neurologie-Psychiatrie.

[19]  G. Ojemann,et al.  Multidisciplinary prediction of seizure relief from cortical resection surgery , 1986, Annals of neurology.

[20]  M. Kurachi,et al.  Lennox-Gastaut syndrome with and without Dandy-Walker malformation , 1987, Epilepsy Research.

[21]  J. Duncan,et al.  Seizure characteristics, pathology, and outcome after temporal lobectomy , 1987, Neurology.

[22]  M. Botez,et al.  Cerebellar Atrophy in Epileptic Patients , 1988, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[23]  H. Masur,et al.  Cerebellar atrophy following acute intoxication with phenytoin , 1989, Neurology.

[24]  M. Mandelkern,et al.  Neuroimaging in Temporal Lobe Epilepsy: Test Sensitivity and Relationships to Pathology and Postoperative Outcome , 1992, Epilepsia.

[25]  L. Cyr,et al.  Measures of clinical agreement for nominal and categorical data: the kappa coefficient. , 1992, Computers in biology and medicine.

[26]  J. Engel,et al.  Update on surgical treatment of the epilepsies. , 1992, Clinical and experimental neurology.

[27]  R. Kuzniecky,et al.  Predictive value of magnetic resonance imaging in temporal lobe epilepsy surgery. , 1993, Archives of neurology.

[28]  R. Fisher,et al.  Cerebellar and thalamic stimulation for epilepsy. , 1993, Advances in neurology.

[29]  Jerome Engel,et al.  Outcome with respect to epileptic seizures. , 1993 .

[30]  J. Engel.  Update on surgical treatment of the epilepsies , 1993, Neurology.

[31]  Orrin Devinsky,et al.  Electrical and Magnetic Stimulation of the Brain and Spinal Cord , 1993 .

[32]  John W. Miller,et al.  Role of the Fastigial Nucleus in Generalized Seizures as Demonstrated by GABA Agonist Microinjections , 1993, Epilepsia.

[33]  R. Worth,et al.  Clinical characteristics and predictive factors in 98 patients with complex partial seizures treated with temporal resection. , 1994, Archives of neurology.

[34]  G Lantos,et al.  Cerebellar atrophy in patients with long-term phenytoin exposure and epilepsy. , 1994, Archives of neurology.

[35]  P. Wolf,et al.  Cerebellar atrophy does not increase susceptibility to carbamazepine toxicity , 1994, Acta neurologica Scandinavica.

[36]  J. Girvin,et al.  Effectiveness of temporal lobectomy measured by yearly follow-up and multivariate analysis , 1994 .

[37]  W P Dillon,et al.  Prognostic Value of Qualitative Magnetic Resonance Imaging Hippocampal Abnormalities in Patients Undergoing Temporal Lobectomy for Medically Refractory Seizures , 1994, Epilepsia.

[38]  P. Copple.  The Treatment of Epilepsy: Principles and Practices , 1994 .

[39]  G. Jackson,et al.  Preoperative MRI predicts outcome of temporal lobectomy , 1995, Neurology.

[40]  Hermann Ackermann,et al.  Cerebellar contributions to cognition , 1995, Behavioural Brain Research.