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Medicine Sep 2018Temporal lobe necrosis as result of radiation for nasopharyngeal cancer (NPC) occurs up to 28% of NPC patients. The only effective mitigation is by strict adherence to...
Temporal lobe necrosis as result of radiation for nasopharyngeal cancer (NPC) occurs up to 28% of NPC patients. The only effective mitigation is by strict adherence to temporal lobe dose tolerances during radiotherapy planning, which in turn hinges on accurate temporal lobe delineation. We aim to improve the accuracy and to standardize temporal lobe contouring for patients receiving head and neck radiotherapy for NPC in a tertiary teaching hospital in Singapore.The baseline data were obtained from 10 patients in the diagnostic phase and the effect of interventions were measured in 37 patients who underwent head and neck radiotherapy over a 6-month period.We conducted the project based on the Clinical Practice Improvement Program methodology. The baseline pooled mean percentage variation in temporal lobe contouring was 39.9% (0.8%-60.2%). There was a low level of temporal lobe contouring concordance and this provided the impetus for implementation of strategies to improve the accuracy and reproducibility of temporal lobe contouring. The interventions included supervision and training of radiation therapists and residents in temporal lobe contouring, and standardization of temporal lobe contouring with a protocol and contouring atlas.Thirty-seven patients were treated during the study period from June to November 2014. Following implementation of the first set of interventions, the pooled mean percentage variation in temporal lobe contouring decreased but was not sustained. The implementation of the second set of interventions resulted in a decrease from 39.9% (January to September 2014) to 17.3% (October to November 2014) where P = .004 using t test. Weekly variation was seen throughout the study period but the decrease was sustained after standardizing and providing a contouring atlas for temporal lobe contouring.Temporal lobe contouring can be standardized through effective implementation of a temporal lobe contouring protocol and atlas.
Topics: Adult; Clinical Protocols; Female; Health Plan Implementation; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms; Program Evaluation; Quality Improvement; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Temporal Lobe
PubMed: 30235702
DOI: 10.1097/MD.0000000000012381 -
Epileptic Disorders : International... Sep 2009The purpose of this pilot study was to compare the performance of patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE) on cognitively-based daily...
The purpose of this pilot study was to compare the performance of patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE) on cognitively-based daily living tasks. The hypothesis was that patients with TLE would demonstrate relatively more impairment on a test of everyday memory, while patients with FLE would demonstrate relatively more impairment on a test of everyday executive function. The five Daily Living subtests of the Neuropsychological Assessment Battery (NAB) were administered to twenty-five patients with TLE and nine patients with FLE. The two groups were matched on all demographic variables. The hypothesis was not confirmed: the TLE and FLE patient groups did not demonstrate a double dissociation in memory and executive daily functioning. Rather, both groups were significantly impaired in daily memory functioning, while their executive daily functioning test scores were within normal limits. Relative deficits were also noted in attention in the TLE group and in language in the FLE group, suggesting that despite having focal lesions, functional impairments may be seen in a broad range of daily activities in these patient groups. Generalizability of the findings is limited due to the small number of subjects and because the everyday cognition measures employed may not have been adequately sensitive. Future studies are needed with larger sample sizes to provide a better understanding of how cognitive impairment in epilepsy is associated with deficits in daily functioning.
Topics: Activities of Daily Living; Adult; Cognition; Electroencephalography; Epilepsy, Frontal Lobe; Epilepsy, Temporal Lobe; Executive Function; Female; Humans; Magnetic Resonance Imaging; Male; Neuropsychological Tests; Pilot Projects
PubMed: 19713170
DOI: 10.1684/epd.2009.0265 -
Epilepsia 2000Temporal lobe epilepsy (TLE) is the most common type of medically intractable partial epilepsy amenable to surgery. In the majority of cases, the underlying pathology in... (Review)
Review
Temporal lobe epilepsy (TLE) is the most common type of medically intractable partial epilepsy amenable to surgery. In the majority of cases, the underlying pathology in temporal lobe epilepsy is mesial temporal sclerosis (MTS). Whereas historically invasive recordings were required for most epilepsy surgeries, indications have dramatically changed since the introduction of high-resolution MRI, which uncovers structural lesions in a high percentage of cases. No invasive recordings are required to perform a temporal lobectomy in patients with intractable epilepsy who have structural imaging suggesting unilateral MTS and concordant interictal and ictal surface EEG recordings, functional imaging, and clinical findings. Invasive testing is needed if there is evidence of bitemporal MTS on structural imaging and/or electrophysiologically, and additional information from functional imaging, neuropsychology, and the intracarotid amobarbital (Wada) test also does not help to lateralize the epileptogenic zone. Depth electrodes can be particularly helpful in this setting. However, no surgery is indicated, even without invasive recordings, if bitemporal-independent seizures are recorded by surface EEG and all additional testing is inconclusive. Other etiologies of TLE such as a tumor, vascular malformation, encephalomalacia, or congenital developmental abnormality account for about 30% of all patients who undergo epilepsy surgery. Epilepsy surgery is indicated after limited electrophysiologic investigations if neuroimaging and electrophysiology converge. However, approaches for resection in lesional temporal lobe epilepsy vary among centers. Completeness of resection is crucial and invasive recordings may be needed to guide the resection by mapping eloquent cortex and/or to determine the extent of the non-MRI-visible epileptogenic area. Specific approaches for the different pathologies are discussed because there is evidence that the relationship between the lesions visible on MRI and the epileptogenic zone varies among lesions of different pathologies, and therefore variable surgical strategies must be applied.
Topics: Adolescent; Adult; Brain Diseases; Brain Mapping; Brain Neoplasms; Cerebral Cortex; Child; Electrodes, Implanted; Electroencephalography; Epilepsy, Temporal Lobe; Female; Functional Laterality; Hippocampus; Humans; Magnetic Resonance Imaging; Male; Sclerosis; Stereotaxic Techniques; Temporal Lobe
PubMed: 11001338
DOI: 10.1111/j.1528-1157.2000.tb01536.x -
Epilepsia Aug 2004
Topics: Epilepsy, Temporal Lobe; Follow-Up Studies; Hippocampus; Humans; Preoperative Care; Quality of Life; Sclerosis; Treatment Outcome
PubMed: 15270772
DOI: 10.1111/j.0013-9580.2004.14604.x -
Epilepsia Mar 2005
Topics: Adult; Epilepsia Partialis Continua; Epilepsies, Partial; Epilepsy; Epilepsy, Frontal Lobe; Epilepsy, Temporal Lobe; Female; Humans; Male; Middle Aged; Postoperative Complications; Status Epilepticus; Temporal Lobe; Terminology as Topic; Time Factors
PubMed: 15730546
DOI: 10.1111/j.0013-9580.2005.42604.x -
Revista de Neurologia
Topics: Anticonvulsants; Epilepsy, Temporal Lobe; Humans; Magnetic Resonance Imaging
PubMed: 15999322
DOI: No ID Found -
Epilepsia Feb 1998The influence of sleep on the incidence of seizures and the reciprocal effects of epilepsy on sleep were analyzed in 30 patients with intractable partial seizures, all...
PURPOSE
The influence of sleep on the incidence of seizures and the reciprocal effects of epilepsy on sleep were analyzed in 30 patients with intractable partial seizures, all candidates for surgery.
METHODS
The patients were classified into two groups of 15 patients according to the documented site of the epileptogenic zone: frontal lobe epilepsy (FLE) and medial temporal lobe epilepsy (TLE). Frequency and waking-sleep distribution of seizures were evaluated by continuous video-EEG monitoring for 5 days, under defined antiepileptic drug (AED), sleep, and sleep deprivation regimens. Sleep organization was analyzed by polysomnography prior to the presurgical protocol.
RESULTS
Significant differences were found between the two groups in sleeping-waking distribution of seizures under varied conditions, and in the quality of sleep organization. In FLE patients, seizures most often occurred during sleep, although sleep organization was normal. In TLE patients, most seizures occurred while patients were awake, and sleep organization was characterized by a low efficiency index. The difference in seizure distribution between FLE and TLE persisted under all conditions investigated, i.e., after AED discontinuation and sleep deprivation.
CONCLUSIONS
Sleep recording may be useful for diagnosis of FLE, and monitoring after sleep deprivation for that of TLE. We speculate that sleep-related seizures in FLE may depend on interaction between frontal lobe areas with the thalamus cortical synchronization system and the acetylcholine regulatory system of waking.
Topics: Adult; Electroencephalography; Epilepsy, Frontal Lobe; Epilepsy, Temporal Lobe; Female; Frontal Lobe; Humans; Male; Monitoring, Physiologic; Polysomnography; Sleep; Sleep Deprivation; Sleep Wake Disorders; Temporal Lobe; Videotape Recording; Wakefulness
PubMed: 9577994
DOI: 10.1111/j.1528-1157.1998.tb01352.x -
Epilepsia 1997Neuropsychology has played a prominent role throughout the modern era of epilepsy surgery. Neuropsychology, including the Wada test, has been of benefit in documenting... (Review)
Review
Neuropsychology has played a prominent role throughout the modern era of epilepsy surgery. Neuropsychology, including the Wada test, has been of benefit in documenting dysfunction associated with a lateralized temporal lobe seizure onset. In addition, neuropsychological results have some predicative power regarding seizure outcome following anterior temporal lobectomy. The current status of neuropsychology in patient evaluation and outcome prediction will be presented. Differences between the Wada test, an inactivation procedure, and functional magnetic resonance imaging, which is an activation procedure, will be discussed. This paper will also present preliminary information about the Wechsler Adult Intelligence Scale-III, the recent revision of the most commonly used test of intellectual function, and its effects on neuropsychological performance results.
Topics: Adult; Amobarbital; Brain Mapping; Epilepsy, Temporal Lobe; Functional Laterality; Humans; Magnetic Resonance Imaging; Neuropsychological Tests; Stereotaxic Techniques; Task Performance and Analysis; Temporal Lobe; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Wechsler Scales
PubMed: 9240237
DOI: 10.1111/j.1528-1157.1997.tb04535.x -
Seizure May 2023
Topics: Humans; Epilepsy, Temporal Lobe; Ataxia; Cerebellar Ataxia; Pedigree; Mutation; Calcium Channels
PubMed: 37059034
DOI: 10.1016/j.seizure.2023.03.019 -
Journal of Neurology, Neurosurgery, and... Jun 1987The aura experience of 88 patients with temporal lobe epilepsy was recorded, classified and analysed. Despite the great richness of the 215 experiences described,...
The aura experience of 88 patients with temporal lobe epilepsy was recorded, classified and analysed. Despite the great richness of the 215 experiences described, correlations with left or right brain, nature of lesion, age of onset, etc. were only apparent when a classification into three aura groups was used. "Simple primitive" auras as sole auras were more likely with early onset epilepsy, in lower IQ patients, in males, from the right temporal lobe, and with mesial temporal sclerosis. Exclusively "intellectual" auras were confined to a group of high IQ males. The number of aura experiences described per person correlated with Verbal IQ for males but not females, but also varied with side, sex, and nature of lesion. The results are discussed in terms of the necessary conditions for aura and their relevance and in relationship to the results of brain stimulation studies by Penfield and others.
Topics: Epilepsy, Temporal Lobe; Female; Functional Laterality; Humans; Intelligence; Male; Sex Factors; Wechsler Scales
PubMed: 3612148
DOI: 10.1136/jnnp.50.6.673