Neurophysiologic and neuroradiologic features of intractable epilepsy after traumatic brain injury in adults

Ramon Diaz-Arrastia, Mark A. Agostini, Alan B. Frol, Bruce Mickey, James Fleckenstein, Eileen Bigio, Paul C. Van Ness

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

Background: There is controversy regarding the precise mechanism by which epilepsy results after traumatic brain injury (TBI). Previous reports have suggested that mesial temporal lobe epilepsy may result from TBI only in young children, while neocortical epilepsy arises from TBI in later life. These conclusions were based on surgical series and may be biased because of patient selection. Objective: To determine the frequency of mesial temporal lobe as opposed to neocortical epilepsy in patients with intractable epilepsy resulting from TBI after the age of 10 years. Patients and Methods: We identified 23 patients with intractable epilepsy who had TBI after the age of 10 years, preceding the onset of epilepsy. Patients were studied by simultaneous videotape and scalp electroencephalographic recording of typical seizures; magnetic resonance imaging; neuropsychologic studies; and, when appropriate, intracarotid amobarbital testing. Two patients underwent anterior temporal lobectomies. Results: Of the 23 patients, 8 (35%) had mesial temporal lobe epilepsy, based on the finding of hippocampal sclerosis on a magnetic resonance imaging scan, consistent interictal and ictal electroencephalographic recordings, evidence of temporal lobe dysfunction on neuropsychologic testing, and characteristic seizure semiology. Two of these patients underwent anterior temporal lobectomies with clinical benefit, and hippocampal sclerosis was confirmed pathologically. In 2 cases, patients were not treated surgically because of bilateral temporal lobe dysfunction noted on intracarotid amobarbital testing. Eleven patients had neocortical epilepsy; 1 had primary generalized epilepsy; and, in 3, the site of seizure onset was not localized. Conclusions: Mesial temporal lobe epilepsy can result from TBI in adolescents and adults as well as in children, and can often be bilateral and associated with multifocal injury. This information may be useful in developing prophylactic therapy for posttraumatic epilepsy.

Original languageEnglish (US)
Pages (from-to)1611-1616
Number of pages6
JournalArchives of Neurology
Volume57
Issue number11
StatePublished - 2000

Fingerprint

Epilepsy
Temporal Lobe Epilepsy
Temporal Lobe
Anterior Temporal Lobectomy
Amobarbital
Seizures
Sclerosis
Magnetic Resonance Imaging
Drug Resistant Epilepsy
Traumatic Brain Injury
Generalized Epilepsy
Videotape Recording
Scalp
Patient Selection
Stroke
Wounds and Injuries
Testing
Therapeutics
Onset

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Diaz-Arrastia, R., Agostini, M. A., Frol, A. B., Mickey, B., Fleckenstein, J., Bigio, E., & Van Ness, P. C. (2000). Neurophysiologic and neuroradiologic features of intractable epilepsy after traumatic brain injury in adults. Archives of Neurology, 57(11), 1611-1616.

Neurophysiologic and neuroradiologic features of intractable epilepsy after traumatic brain injury in adults. / Diaz-Arrastia, Ramon; Agostini, Mark A.; Frol, Alan B.; Mickey, Bruce; Fleckenstein, James; Bigio, Eileen; Van Ness, Paul C.

In: Archives of Neurology, Vol. 57, No. 11, 2000, p. 1611-1616.

Research output: Contribution to journalArticle

Diaz-Arrastia, R, Agostini, MA, Frol, AB, Mickey, B, Fleckenstein, J, Bigio, E & Van Ness, PC 2000, 'Neurophysiologic and neuroradiologic features of intractable epilepsy after traumatic brain injury in adults', Archives of Neurology, vol. 57, no. 11, pp. 1611-1616.
Diaz-Arrastia, Ramon ; Agostini, Mark A. ; Frol, Alan B. ; Mickey, Bruce ; Fleckenstein, James ; Bigio, Eileen ; Van Ness, Paul C. / Neurophysiologic and neuroradiologic features of intractable epilepsy after traumatic brain injury in adults. In: Archives of Neurology. 2000 ; Vol. 57, No. 11. pp. 1611-1616.
@article{922c3b0d65b84bc890e1077b311d4f67,
title = "Neurophysiologic and neuroradiologic features of intractable epilepsy after traumatic brain injury in adults",
abstract = "Background: There is controversy regarding the precise mechanism by which epilepsy results after traumatic brain injury (TBI). Previous reports have suggested that mesial temporal lobe epilepsy may result from TBI only in young children, while neocortical epilepsy arises from TBI in later life. These conclusions were based on surgical series and may be biased because of patient selection. Objective: To determine the frequency of mesial temporal lobe as opposed to neocortical epilepsy in patients with intractable epilepsy resulting from TBI after the age of 10 years. Patients and Methods: We identified 23 patients with intractable epilepsy who had TBI after the age of 10 years, preceding the onset of epilepsy. Patients were studied by simultaneous videotape and scalp electroencephalographic recording of typical seizures; magnetic resonance imaging; neuropsychologic studies; and, when appropriate, intracarotid amobarbital testing. Two patients underwent anterior temporal lobectomies. Results: Of the 23 patients, 8 (35{\%}) had mesial temporal lobe epilepsy, based on the finding of hippocampal sclerosis on a magnetic resonance imaging scan, consistent interictal and ictal electroencephalographic recordings, evidence of temporal lobe dysfunction on neuropsychologic testing, and characteristic seizure semiology. Two of these patients underwent anterior temporal lobectomies with clinical benefit, and hippocampal sclerosis was confirmed pathologically. In 2 cases, patients were not treated surgically because of bilateral temporal lobe dysfunction noted on intracarotid amobarbital testing. Eleven patients had neocortical epilepsy; 1 had primary generalized epilepsy; and, in 3, the site of seizure onset was not localized. Conclusions: Mesial temporal lobe epilepsy can result from TBI in adolescents and adults as well as in children, and can often be bilateral and associated with multifocal injury. This information may be useful in developing prophylactic therapy for posttraumatic epilepsy.",
author = "Ramon Diaz-Arrastia and Agostini, {Mark A.} and Frol, {Alan B.} and Bruce Mickey and James Fleckenstein and Eileen Bigio and {Van Ness}, {Paul C.}",
year = "2000",
language = "English (US)",
volume = "57",
pages = "1611--1616",
journal = "Archives of Neurology",
issn = "0003-9942",
publisher = "American Medical Association",
number = "11",

}

TY - JOUR

T1 - Neurophysiologic and neuroradiologic features of intractable epilepsy after traumatic brain injury in adults

AU - Diaz-Arrastia, Ramon

AU - Agostini, Mark A.

AU - Frol, Alan B.

AU - Mickey, Bruce

AU - Fleckenstein, James

AU - Bigio, Eileen

AU - Van Ness, Paul C.

PY - 2000

Y1 - 2000

N2 - Background: There is controversy regarding the precise mechanism by which epilepsy results after traumatic brain injury (TBI). Previous reports have suggested that mesial temporal lobe epilepsy may result from TBI only in young children, while neocortical epilepsy arises from TBI in later life. These conclusions were based on surgical series and may be biased because of patient selection. Objective: To determine the frequency of mesial temporal lobe as opposed to neocortical epilepsy in patients with intractable epilepsy resulting from TBI after the age of 10 years. Patients and Methods: We identified 23 patients with intractable epilepsy who had TBI after the age of 10 years, preceding the onset of epilepsy. Patients were studied by simultaneous videotape and scalp electroencephalographic recording of typical seizures; magnetic resonance imaging; neuropsychologic studies; and, when appropriate, intracarotid amobarbital testing. Two patients underwent anterior temporal lobectomies. Results: Of the 23 patients, 8 (35%) had mesial temporal lobe epilepsy, based on the finding of hippocampal sclerosis on a magnetic resonance imaging scan, consistent interictal and ictal electroencephalographic recordings, evidence of temporal lobe dysfunction on neuropsychologic testing, and characteristic seizure semiology. Two of these patients underwent anterior temporal lobectomies with clinical benefit, and hippocampal sclerosis was confirmed pathologically. In 2 cases, patients were not treated surgically because of bilateral temporal lobe dysfunction noted on intracarotid amobarbital testing. Eleven patients had neocortical epilepsy; 1 had primary generalized epilepsy; and, in 3, the site of seizure onset was not localized. Conclusions: Mesial temporal lobe epilepsy can result from TBI in adolescents and adults as well as in children, and can often be bilateral and associated with multifocal injury. This information may be useful in developing prophylactic therapy for posttraumatic epilepsy.

AB - Background: There is controversy regarding the precise mechanism by which epilepsy results after traumatic brain injury (TBI). Previous reports have suggested that mesial temporal lobe epilepsy may result from TBI only in young children, while neocortical epilepsy arises from TBI in later life. These conclusions were based on surgical series and may be biased because of patient selection. Objective: To determine the frequency of mesial temporal lobe as opposed to neocortical epilepsy in patients with intractable epilepsy resulting from TBI after the age of 10 years. Patients and Methods: We identified 23 patients with intractable epilepsy who had TBI after the age of 10 years, preceding the onset of epilepsy. Patients were studied by simultaneous videotape and scalp electroencephalographic recording of typical seizures; magnetic resonance imaging; neuropsychologic studies; and, when appropriate, intracarotid amobarbital testing. Two patients underwent anterior temporal lobectomies. Results: Of the 23 patients, 8 (35%) had mesial temporal lobe epilepsy, based on the finding of hippocampal sclerosis on a magnetic resonance imaging scan, consistent interictal and ictal electroencephalographic recordings, evidence of temporal lobe dysfunction on neuropsychologic testing, and characteristic seizure semiology. Two of these patients underwent anterior temporal lobectomies with clinical benefit, and hippocampal sclerosis was confirmed pathologically. In 2 cases, patients were not treated surgically because of bilateral temporal lobe dysfunction noted on intracarotid amobarbital testing. Eleven patients had neocortical epilepsy; 1 had primary generalized epilepsy; and, in 3, the site of seizure onset was not localized. Conclusions: Mesial temporal lobe epilepsy can result from TBI in adolescents and adults as well as in children, and can often be bilateral and associated with multifocal injury. This information may be useful in developing prophylactic therapy for posttraumatic epilepsy.

UR - http://www.scopus.com/inward/record.url?scp=0033734198&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033734198&partnerID=8YFLogxK

M3 - Article

VL - 57

SP - 1611

EP - 1616

JO - Archives of Neurology

JF - Archives of Neurology

SN - 0003-9942

IS - 11

ER -