Intracranial, intraaxial, space-occupying lesions in patients with intractable partial seizures: an anatomoclinical, neuropsychological, and surgical correlation

Epilepsia. Jul-Aug 1991;32(4):467-76. doi: 10.1111/j.1528-1157.1991.tb04679.x.

Abstract

Fifty of approximately 250 patients evaluated for intractable partial seizures were shown to have a space-occupying lesion detected with radiographs and/or neuroimaging. Twenty-eight males and 22 females had a mean age at seizure onset of 13 years and a mean duration of seizures of 11 years. All patients had closed-circuit television with EEG monitoring and complete neurologic and neuropsychological assessment. Findings were correlated with lesion location and surgical data. Twenty-seven lesions (54%) were located in the temporal lobe. Thirty-five lesions (70%) were neoplastic. All patients with temporal lobe lesions had complex partial seizures, as did 74% of patients with extratemporal lesions. A good correlation between clinical seizure characteristics and lesion localization was found with the temporal, occipital, and frontal lesions but not with the parietal lesions. Sixty-six percent of patients had focal interictal EEG findings. Lateralization corresponded to the side of the lesion in 64% and was localized to the region of the lesion in 30%. Lateralized ictal EEGs occurred in 58% of patients, corresponding with the side of the lesion in all but one patient. Abnormal findings on neuropsychological testing were congruent with lesion lateralization in 56% of patients and were localized to the region in 26%. Thirty-nine of 47 patients who underwent a subtotal lobectomy to include the lesion are seizure-free after greater than or equal to 1 year of follow-up, and five others are markedly improved.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Brain / diagnostic imaging
  • Brain / physiopathology*
  • Brain Neoplasms / diagnosis*
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / physiopathology
  • Cerebral Cortex / diagnostic imaging
  • Cerebral Cortex / physiopathology
  • Electroencephalography
  • Epilepsies, Partial / diagnosis*
  • Epilepsies, Partial / diagnostic imaging
  • Epilepsies, Partial / physiopathology
  • Functional Laterality / physiology
  • Humans
  • Neuropsychological Tests
  • Radiography