Association of magnetic resonance imaging identification of mesial temporal sclerosis with pathological diagnosis and surgical outcomes in children following epilepsy surgery

Clinical article

Restricted access

Object

Mesial temporal sclerosis (MTS) is widely recognized as a significant underlying cause of temporal lobe epilepsy. Magnetic resonance imaging is routinely used in the preoperative evaluation of children with epilepsy. The purpose of this study was to evaluate the prevalence, reliability, and prognostic value of MRI identification of MTS and MRI findings indicative of MTS in a series of patients who underwent resection of the medial temporal lobe for medically refractory epilepsy.

Methods

The authors reviewed the medical records and preoperative MRI reports of 25 patients who had undergone medial temporal resections (anterior temporal lobectomy or functional hemispherotomy) for medically intractable epilepsy. The preoperative MRI studies were presented for blinded review by 2 neuroradiologists who independently evaluated the radiographs for selected MTS features and provided a final interpretation. To quantify interrater agreement and accuracy, the findings of the 2 blinded neuroradiologists, the nonblinded clinical preoperative radiology report, and the final pathology interpretation were compared.

Results

The preoperative MRI studies revealed MTS in 6 patients (24%), and histopathological analysis verified MTS in 8 (32%) of 25 specimens. Six MRI features of MTS were specifically evaluated: 1) increased hippocampal signal intensity, 2) reduced hippocampal size, 3) atrophy of the ipsilateral hippocampal collateral white matter, 4) enlarged ipsilateral temporal horn, 5) reduced gray-white matter demarcation in the temporal lobe, and 6) decreased temporal lobe size. The most prevalent feature of MTS identified on MRI was a reduced hippocampal size, found in 11 of the MRI studies (44%). Analysis revealed moderate interrater agreement for MRI identification of MTS between the 2 blinded neuroradiologists and the nonblinded preoperative report (Cohen κ 0.40–0.59). Interrater agreement was highly variable for different MTS features indicative of MTS, ranging from poor to near perfect. Agreement was highest for increased hippocampal signal and decreased temporal lobe size and was consistently poor for reduced gray-white matter demarcation. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and proportion perfect agreement were highest for increased hippocampal signal and reduced hippocampal size. An MRI finding of MTS was not predictive of seizure outcome in this small series.

Conclusions

Mesial temporal sclerosis identification on brain MRI in children evaluated for medial temporal resections has a PPV of 55%–67% and an NPV of 79%–87%. Increased hippocampal signal and reduced hippocampal size were associated with high predictive values, while gray-white differentiation and an enlarged temporal horn were not predictive of MTS. Seizure outcome following medial temporal resections was not associated with MRI findings of MTS or MRI abnormalities indicative of MTS in this small sample size.

Abbreviations used in this paper:ATL = anterior temporal lobectomy; EEG = electroencephalography; FH = functional hemispherotomy; MTS = mesial temporal sclerosis; NPV = negative predictive value; PPV = positive predictive value.

Article Information

Address correspondence to: Aimen S. Kasasbeh, M.D., Ph.D., Department of Neuroscience, University of Arizona, 1548 East Drachman Street, P.O. Box 210476, Tucson, Arizona 85719. email: aimenk@email.arizona.edu.

Please include this information when citing this paper: DOI: 10.3171/2012.1.PEDS11447.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Left: Coronal T2-weighted MR image demonstrating high signal intensity in the left hippocampus (arrowhead), reduced left hippocampal size, and enlarged temporal horn of the left lateral ventricle (arrow). Right: Coronal FLAIR image showing left MTS. Six of the selected MTS features are as follows: high signal intensity of the left hippocampus and decreased hippocampal size (arrowhead), atrophy of the ipsilateral hippocampal collateral white matter (normal contralateral hippocampal collateral white matter marked with an asterisk), enlarged ipsilateral temporal horn (solid arrow), decreased gray-white matter demarcation of the left temporal lobe (open arrow), and decreased left temporal lobe size. Ex vacuo dilation of the left lateral ventricle is visible.

References

1

Berkovic SFAndermann FOlivier AEthier RMelanson DRobitaille Y: Hippocampal sclerosis in temporal lobe epilepsy demonstrated by magnetic resonance imaging. Ann Neurol 29:1751821991

2

Blume WT: Temporal lobe epilepsy surgery in childhood: rationale for greater use. Can J Neurol Sci 24:95981997

3

Bocti CRobitaille YDiadori PLortie AMercier CBouthillier A: The pathological basis of temporal lobe epilepsy in childhood. Neurology 60:1911952003

4

Bourgeois BF: Temporal lobe epilepsy in infants and children. Brain Dev 20:1351411998

5

Bronen RACheung GCharles JTKim JHSpencer DDSpencer SS: Imaging findings in hippocampal sclerosis: correlation with pathology. AJNR Am J Neuroradiol 12:9339401991

6

Brooks BSKing DWel Gammal TMeador KYaghmai FGay JN: MR imaging in patients with intractable complex partial epileptic seizures. AJNR Am J Neuroradiol 11:93991990

7

Cascino GDJack CR JrParisi JESharbrough FWHirschorn KAMeyer FB: Magnetic resonance imaging-based volume studies in temporal lobe epilepsy: pathological correlations. Ann Neurol 30:31361991

8

Ciliberto MALimbrick DPowers ATitus JBMunro RSmyth MD: Palliative hemispherotomy in children with bilateral seizure onset. Clinical article. J Neurosurg Pediatr 9:3813882012

9

Cross JHJackson GDNeville BGConnelly AKirkham FJBoyd SG: Early detection of abnormalities in partial epilepsy using magnetic resonance. Arch Dis Child 69:1041091993

10

Davidson SFalconer MA: Outcome of surgery in 40 children with temporal-lobe epilepsy. Lancet 1:126012631975

11

DeLong GRHeinz ER: The clinical syndrome of early-life bilateral hippocampal sclerosis. Ann Neurol 42:11171997

12

Dowd CFDillon WPBarbaro NMLaxer KD: Magnetic resonance imaging of intractable complex partial seizures: pathologic and electroencephalographic correlation. Epilepsia 32:4544591991

13

Duchowny MLevin BJayakar PResnick TJ: Neurobiologic considerations in early surgery for epilepsy. J Child Neurol 9:Suppl 242491994

14

Engel J JrVan Ness PCRasmussen TBOjemann LMOutcome with respect to epileptic seizures. Engel J Jr: Surgical Treatment of the Epilepsies New YorkRaven Press1993. 609621

15

Gilliam FWyllie EKashden JFaught EKotagal PBebin M: Epilepsy surgery outcome: comprehensive assessment in children. Neurology 48:136813741997

16

Grattan-Smith JDHarvey ASDesmond PMChow CW: Hippocampal sclerosis in children with intractable temporal lobe epilepsy: detection with MR imaging. AJR Am J Roentgenol 161:104510481993

17

Harbord MGManson JI: Temporal lobe epilepsy in childhood: reappraisal of etiology and outcome. Pediatr Neurol 3:2632681987

18

Harvey ASBerkovic SFWrennall JAHopkins IJ: Temporal lobe epilepsy in childhood: clinical, EEG, and neuroimaging findings and syndrome classification in a cohort with new-onset seizures. Neurology 49:9609681997

19

Harvey ASGrattan-Smith JDDesmond PMChow CWBerkovic SF: Febrile seizures and hippocampal sclerosis: frequent and related findings in intractable temporal lobe epilepsy of childhood. Pediatr Neurol 12:2012061995

20

Heinz ERCrain BJRadtke RABurger PCFriedman AHDjang WT: MR imaging in patients with temporal lobe seizures: correlation of results with pathologic findings. AJNR Am J Neuroradiol 11:8278321990

21

Jack CR JrSharbrough FWTwomey CKCascino GDHirschorn KAMarsh WR: Temporal lobe seizures: lateralization with MR volume measurements of the hippocampal formation. Radiology 175:4234291990

22

Jackson GDBadawy RA: Selecting patients for epilepsy surgery: identifying a structural lesion. Epilepsy Behav 20:1821892011

23

Jackson GDBerkovic SFDuncan JSConnelly A: Optimizing the diagnosis of hippocampal sclerosis using MR imaging. AJNR Am J Neuroradiol 14:7537621993

24

Jarrar RGBuchhalter JRMeyer FBSharbrough FWLaws E: Long-term follow-up of temporal lobectomy in children. Neurology 59:163516372002

25

Jay VBecker LEOtsubo HHwang PAHoffman HJHarwood-Nash D: Pathology of temporal lobectomy for refractory seizures in children. Review of 20 cases including some unique malformative lesions. J Neurosurg 79:53611993

26

Kan PVan Orman CKestle JR: Outcomes after surgery for focal epilepsy in children. Childs Nerv Syst 24:5875912008

27

Kilpatrick CO'Brien TMatkovic ZCook MKaye A: Preoperative evaluation for temporal lobe surgery. J Clin Neurosci 10:5355392003

28

King MANewton MRJackson GDFitt GJMitchell LASilvapulle MJ: Epileptology of the first-seizure presentation: a clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients. Lancet 352:100710111998

29

Kuzniecky Rde la Sayette VEthier RMelanson DAndermann FBerkovic S: Magnetic resonance imaging in temporal lobe epilepsy: pathological correlations. Ann Neurol 22:3413471987

30

Kuzniecky RMurro AKing DMorawetz RSmith JPowers R: Magnetic resonance imaging in childhood intractable partial epilepsies: pathologic correlations. Neurology 43:6816871993

31

Landis JRKoch GG: The measurement of observer agreement for categorical data. Biometrics 33:1591741977

32

Limbrick DDNarayan PPowers AKOjemann JGPark TSBertrand M: Hemispherotomy: efficacy and analysis of seizure recurrence. Clinical article. J Neurosurg Pediatr 4:3233322009

33

Lindsay JOunsted CRichards P: Long-term outcome in children with temporal lobe seizures. I: Social outcome and childhood factors. Dev Med Child Neurol 21:2852981979

34

Liu ZMikati MHolmes GL: Mesial temporal sclerosis: pathogenesis and significance. Pediatr Neurol 12:5161995

35

Meiners LCvan Gils AJansen GHde Kort GWitkamp TDRamos LM: Temporal lobe epilepsy: the various MR appearances of histologically proven mesial temporal sclerosis. AJNR Am J Neuroradiol 15:154715551994

36

Mittal SMontes JLFarmer JPRosenblatt BDubeau FAndermann F: Long-term outcome after surgical treatment of temporal lobe epilepsy in children. J Neurosurg 103:5 Suppl4014122005

37

Mohamed AWyllie ERuggieri PKotagal PBabb THilbig A: Temporal lobe epilepsy due to hippocampal sclerosis in pediatric candidates for epilepsy surgery. Neurology 56:164316492001

38

Ng YTMcGregor ALDuane DCJahnke HKBird CRWheless JW: Childhood mesial temporal sclerosis. J Child Neurol 21:5125172006

39

Ng YTMcGregor ALWheless JW: Magnetic resonance imaging detection of mesial temporal sclerosis in children. Pediatr Neurol 30:81852004

40

Roulet-Perez EDavidoff VMayor-Dubois CMaeder-Ingvar MSeeck MRuffieux C: Impact of severe epilepsy on development: recovery potential after successful early epilepsy surgery. Epilepsia 51:126612762010

41

Salanova VMarkand OWorth RGarg BPatel HAsconape J: Presurgical evaluation and surgical outcome of temporal lobe epilepsy. Pediatr Neurol 20:1791841999

42

Sinclair DBAronyk KSnyder TMcKean JWheatley MBhargava R: Pediatric temporal lobectomy for epilepsy. Pediatr Neurosurg 38:1952052003

43

Sinclair DBWheatley MAronyk KHao CSnyder TColmers W: Pathology and neuroimaging in pediatric temporal lobectomy for intractable epilepsy. Pediatr Neurosurg 35:2392462001

44

Smyth MDLimbrick DD JrOjemann JGZempel JRobinson SO'Brien DF: Outcome following surgery for temporal lobe epilepsy with hippocampal involvement in preadolescent children: emphasis on mesial temporal sclerosis. J Neurosurg 106:3 Suppl2052102007

45

Terra-Bustamante VCInuzuca LMFernandes RMFunayama SEscorsi-Rosset SWichert-Ana L: Temporal lobe epilepsy surgery in children and adolescents: clinical characteristics and post-surgical outcome. Seizure 14:2742812005

46

Vernet OFarmer JPMontes JLVillemure JGMeagher-Villemure K: Dysgenetic mesial temporal sclerosis: an unrecognized entity. Childs Nerv Syst 16:7197232000

47

Wyllie E: Surgical treatment of epilepsy in pediatric patients. Can J Neurol Sci 27:1061102000

48

Wyllie EComair YGKotagal PBulacio JBingaman WRuggieri P: Seizure outcome after epilepsy surgery in children and adolescents. Ann Neurol 44:7407481998

49

Zupanc ML: Neuroimaging in the evaluation of children and adolescents with intractable epilepsy: I. Magnetic resonance imaging and the substrates of epilepsy. Pediatr Neurol 17:19261997

50

Zupanc ML: Neuroimaging in the evaluation of children and adolescents with intractable epilepsy: II. Neuroimaging and pediatric epilepsy surgery. Pediatr Neurol 17:1111211997

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 45 45 13
Full Text Views 95 95 10
PDF Downloads 102 102 4
EPUB Downloads 0 0 0

PubMed

Google Scholar