OBJECTIVE: Refractory epilepsy may have an underlying autoimmune etiology. Our aim was to assess the prevalence of neural autoantibodies in a multicenter national prospective cohort of patients with drug-resistant epilepsy undergoing epilepsy surgery utilizing comprehensive clinical, serologic, and histopathological analyses. METHODS: We prospectively recruited patients undergoing epilepsy surgery for refractory focal epilepsy not caused by a brain tumor from epilepsy surgery centers in the Czech Republic. Perioperatively, we collected cerebrospinal fluid (CSF) and/or serum samples and performed comprehensive commercial and in-house assays for neural autoantibodies. Clinical data were obtained from the patients' medical records, and histopathological analysis of resected brain tissue was performed. RESULTS: Seventy-six patients were included, mostly magnetic resonance imaging (MRI)-lesional cases (74%). Mean time from diagnosis to surgery was 21 ± 13 years. Only one patient (1.3%) had antibodies in the CSF and serum (antibodies against glutamic acid decarboxylase 65) in relevant titers; histology revealed focal cortical dysplasia (FCD) III (FCD associated with hippocampal sclerosis [HS]). Five patients' samples displayed CSF-restricted oligoclonal bands (OCBs; 6.6%): three cases with FCD (one with FCD II and two with FCD I), one with HS, and one with negative histology. Importantly, eight patients (one of them with CSF-restricted OCBs) had findings on antibody testing in individual serum and/or CSF tests that could not be confirmed by complementary tests and were thus classified as nonspecific, yet could have been considered specific without confirmatory testing. Of these, two had FCD, two gliosis, and four HS. No inflammatory changes or lymphocyte cuffing was observed histopathologically in any of the 76 patients. SIGNIFICANCE: Neural autoantibodies are a rare finding in perioperatively collected serum and CSF of our cohort of mostly MRI-lesional epilepsy surgery patients. Confirmatory testing is essential to avoid overinterpretation of autoantibody-positive findings.

• MeSH
• autoprotilátky MeSH
• epilepsie * epidemiologie   chirurgie   komplikace   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• malformace mozkové kůry * komplikace   MeSH
• prevalence MeSH
• prospektivní studie MeSH
• refrakterní epilepsie * diagnostické zobrazování   chirurgie   komplikace   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Concern about postoperative worsening of cognitive functions after temporal lobe epilepsy surgery is an important issue. In this article we review our data on neuropsychological outcome after radiofrequency (RF) ablation of amygdalohippocampal complex (AHC). On a group level we found initial improvement in intelligence domains and unchanged memory scores one year after the surgery. During longitudinal follow-up, we found improvement in both intellectual and memory domains. This improvement was most pronounced up to two years after surgery. On an individual level, no patient worsened in any intellectual domain and most patients improved in memory. We hypothesize that this favorable outcome may be a consequence of minimization of collateral damage and incomplete destruction of target structures. We also summarize our experience with psychiatric complications of the procedure.

• MeSH
• amygdala chirurgie   MeSH
• epilepsie temporálního laloku komplikace   chirurgie   MeSH
• hipokampus chirurgie   MeSH
• lidé MeSH
• mentální retardace etiologie   chirurgie   MeSH
• neuropsychologické testy MeSH
• poruchy paměti etiologie   chirurgie   MeSH
• radiofrekvenční ablace metody   MeSH
• výsledek terapie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

In this article, we provide an overview of the reasons for the introduction of less invasive treatment modalities in the management of intractable mesial temporal lobe epilepsy (mTLE). We summarize our published research on stereotactic amygdalohippocampectomy (SAHE) and recalculate our data for the patients' last visit. In our previous work, we found that patients achieved long-term seizure-free outcomes in 70.5%. Re-analysis of results in a subgroup of patient who were diagnosed and followed-up at Epilepsy Center, Na Homolce Hospital, Prague, indicate that these outcomes are durable. Re-treatment in treatment failures was successful in all cases. The discussion compares novel treatment options and defines the place of SAHE among them.

• MeSH
• amygdala chirurgie   MeSH
• databáze faktografické statistika a číselné údaje   MeSH
• elektroencefalografie MeSH
• epilepsie temporálního laloku diagnostické zobrazování   chirurgie   MeSH
• hipokampus chirurgie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• počítačové zpracování obrazu MeSH
• radiofrekvenční ablace metody   MeSH
• výsledek terapie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVES: Minimally invasive procedures for treating temporal lobe epilepsy have been investigated recently, namely stereotactic and gamma knife amygdalohippocampectomy (AHE). However, the results are not fully satisfactory. Our aim was to evaluate efficacy and side-effects of stereotactic AHE mimicking the neurosurgical procedure in terms of extent of the lesion. METHODS: 16 consecutive patients were assessed using VEEG, MRI, FDG-PET and WADA test. All had definite pharmacoresistant medial temporal lobe epilepsy. The stereotactic AHE was performed on the Leksell stereotactic system. All lesions exceeded 40 mm along the long axis of the hippocamus. RESULTS: Seizure outcome was favourable on one year follow-up: 12 patients (75%) were seizure-free (Engel I), three (19%) were Engel II, and one (6%) was Engel III. Side-effects were mild, lasting up to 7 days: cephalea, meningeal syndrome with sterile CSF in three subjects, and CSF leak lasting up to 3 days in seven subjects. CONCLUSION: Stereotactic AHE encompassing sufficient volume of the amygdalohippocampal complex appears to be safe, effective, and free from long-term side-effects.

• MeSH
• amygdala chirurgie   metabolismus   patologie   MeSH
• dospělí MeSH
• epilepsie temporálního laloku chirurgie   metabolismus   patologie   MeSH
• financování organizované MeSH
• fluorodeoxyglukosa F18 diagnostické užití   MeSH
• hipokampus chirurgie   metabolismus   patologie   MeSH
• léková rezistence MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• neurochirurgické výkony MeSH
• pozitronová emisní tomografie MeSH
• radiofarmaka diagnostické užití   MeSH
• stereotaktické techniky MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH