The Effect of Neocortical Pathology on Lateralization and Seizure Outcome in Lobectomy Materials in Surgically Treated Hippocampal Sclerosis Patients

INTRODUCTION: The aim of this study was to investigate the effect of histopathological neocortical pathology on lateralization and surgical seizure in patients with temporal epilepsy, resistant temporal epilepsy and hippocampal sclerosis. METHODS: In our clinic, from 2008 to 2016, 18 patients with resistant temporal lobe epilepsy and hippocampal sclerosis were included in the study. RESULTS: Thirteen patients (72.2%) right side, 5 patients (27.8%) left side amygdalohipocampectomy + anterior temporal lobectomy procedure was performed. Neocortical pathology was found histopathologically in 11 patients (61.1%) and normal in 7 patients (38.9%). Six (33.3%) of the neocortical pathology were microdisgenesia and 5 (27.8%) were cortical dysplasia. The effect of preoperative examination on lateralization was investigated according to neocortical pathology and normalization of seizure semiology (78.4%) was statistically significant (p = 0.019). The best investigations for lateralization waere cranial MRI (94.5%) and ictal EEG (94.5%). PET (83.3%) investigation was found to contribute to lateralization. Early onset seizures were remarkable in patients with neocortical pathology. In the first 5 years after surgery,according to Engel classification, 83.3% grade 1, 11.1% grade 2, 5.6% grade 3 seizure rates were obtained. There were no statistically significant differences between the patients with neocortical pathology and those with normal surgical results. DISCUSSION AND CONCLUSION: In our study we found that the rate of pathology in neocortical tissue is high in patients with hippocampal sclerosis. This result, supports the standard temporal lobectomy surgical procedure. More studies are needed to determine the effect of the presence of pathology on lateralization value, epileptogenesis and surgical outcomes