Mesial temporal lobe epilepsy: A West Indian Neurosurgical Experience. (2019)

• Record Type: Journal Article
• Authors: Panday, Avidesh; Calderon, Chrystal; Sandy, Sherry; Ramnarine, Devindra
• Is Part Of: International journal of surgery case reports. Volume 65(2019)
• Page Start: 275
• Page End: 278
• Publication Date: 2019
• Subjects: Mesial temporal lobe epilepsy -- Medical refractory epilepsy -- Anterior temporal lobectomy -- Caribbean -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.10.063
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Mesial temporal lobe epilepsy represents a large proportion of medical refractory or drug-resistant epileptic cases. Greater initiatives are mandated for earlier assessment of suitable surgical cases. The combined efforts of multiple disciplines are essential to attaining progress in this endeavour. Surgical intervention provides seizure freedom and significant improvement in quality of life. The first published case of successful epilepsy surgery in the English-speaking Caribbean for temporal lobe epilepsy. Abstract: Introduction: We sought to highlight a case of refractory mesial temporal lobe epilepsy managed via an anterior temporal lobectomy. To our knowledge, this is the first of its kind to be performed and published in the English-speaking Caribbean. Presentation of case: A 44-year-old female, known seizure disorder for 25 years was referred to the outpatient clinic. Several trials of varying anti-epileptic drugs failed to provide remittance of her frequent partial seizures over the last two decades. Magnetic resonance imaging displayed asymmetry of the hippocampus, with a prominent right temporal horn of lateral ventricle, in keeping with right anteromesial temporal lobe sclerosis. She underwent a right anterior temporal lobectomy after exhaustive counselling; with the guidance of a multidisciplinary team. The post-operative period was uneventful and currently, the patient has been seizure-free since operation. Discussion: Drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used anti-epileptic drug schedules to attain sustained seizure freedom. Medical management of mesial temporal lobe epilepsy has a relatively poor long-term outcome, with 30 % of patients falling into the category of pharmaco-resistant. Conclusion: Surgical management of these cases have been proven to be a safe and effective alternative but is currently greatly underutilized. In our literature review, we present the first published case of epilepsy surgery in the English-speaking Caribbean for temporal lobe epilepsy.