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Anterior temporal lobectomy. A cross-sectional observational study of potential surgical candidates at a single institute
Background: Epilepsy is a common neurological disorder, associated with serious cognitive and psychosocial burdens, especially when poorly controlled. Mesial temporal lobe epilepsy (mTLE) is the most common form of human focal epilepsy. It is often refractory to antiepileptic drugs, and the most ame...
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| Format: | Thesis |
| Language: | Eng |
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Department of Medicine
2025
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| _version_ | 1867613164078628864 |
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| access_status_str | Open Access |
| author | Soni, Aayesha |
| author2 | Leepan, Edward |
| author_browse | Leepan, Edward Soni, Aayesha |
| author_facet | Leepan, Edward Soni, Aayesha |
| author_sort | Soni, Aayesha |
| collection | Thesis |
| description | Background: Epilepsy is a common neurological disorder, associated with serious cognitive and psychosocial burdens, especially when poorly controlled. Mesial temporal lobe epilepsy (mTLE) is the most common form of human focal epilepsy. It is often refractory to antiepileptic drugs, and the most amenable to surgical treatment which often renders patients seizure free. Furthermore, surgery for mTLE has low procedural risk, is cost-effective and best performed early in the disease course for maximal benefit. It is surprising, therefore, that mTLE surgery remains widely under-utilised, in both well and poorly resourced settings. Objectives: The aim of this study was to establish the frequency of occurrence of patients with electroencephalographic epileptiform discharges consistent with mTLE attending a neurophysiology laboratory at a tertiary hospital in South Africa, and determine whether these patients may be candidates for anterior temporal lobectomy, the most commonly performed surgery for mTLE. Methods: This was a quantitative audit of all scalp electroencephalograms (EEG) performed at the Groote Schuur Neurophysiology laboratory during the period January 1st 2017 to December 31st 2019. Where CT and MRI brain scans had been performed, these were assessed for corroborative evidence of mTLE. Results: Over the three-year period, 4 342 EEGs were assessed. A total of 411 (11%) showed epileptiform discharges consistent with all epilepsy types. Of these, 327 (69%) were of focal onset and 108 (2% of the total number of EEGs performed) were consistent with mTLE. Of the patients with electroencephalographic features of mTLE, only 27 (25%) had had MRI brain scans performed according to an epilepsy surgery protocol. Of these, 6 exhibited MRI findings confirming mTLE, identifying them as potential surgical candidates. Over three years, 75% of patients with electroencephalographic evidence suggesting mTLE did not receive appropriate work-up for epilepsy surgery. Conclusion: Surgery, especially anterior temporal lobectomy, is widely acknowledged to be an efficacious and cost-effective intervention in patients with medically refractory mTLE. The findings of our study suggest that patients with mTLE are under-investigated for potential surgical management, and that epilepsy surgery is under-utilised in South Africa. These findings are in line with similar studies in both well-resourced and resourceconstrained countries. We hope that our study will highlight the utility of EEG as a screening tool to identify patients with drug-resistant epilepsy due to mTLE, who may be candidates for anterior temporal lobectomy. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/41358 |
| institution | University of Cape Town (South Africa) |
| language | Eng |
| last_indexed | 2026-06-10T12:31:47.142Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/41358 Anterior temporal lobectomy. A cross-sectional observational study of potential surgical candidates at a single institute Soni, Aayesha Leepan, Edward Medicine Background: Epilepsy is a common neurological disorder, associated with serious cognitive and psychosocial burdens, especially when poorly controlled. Mesial temporal lobe epilepsy (mTLE) is the most common form of human focal epilepsy. It is often refractory to antiepileptic drugs, and the most amenable to surgical treatment which often renders patients seizure free. Furthermore, surgery for mTLE has low procedural risk, is cost-effective and best performed early in the disease course for maximal benefit. It is surprising, therefore, that mTLE surgery remains widely under-utilised, in both well and poorly resourced settings. Objectives: The aim of this study was to establish the frequency of occurrence of patients with electroencephalographic epileptiform discharges consistent with mTLE attending a neurophysiology laboratory at a tertiary hospital in South Africa, and determine whether these patients may be candidates for anterior temporal lobectomy, the most commonly performed surgery for mTLE. Methods: This was a quantitative audit of all scalp electroencephalograms (EEG) performed at the Groote Schuur Neurophysiology laboratory during the period January 1st 2017 to December 31st 2019. Where CT and MRI brain scans had been performed, these were assessed for corroborative evidence of mTLE. Results: Over the three-year period, 4 342 EEGs were assessed. A total of 411 (11%) showed epileptiform discharges consistent with all epilepsy types. Of these, 327 (69%) were of focal onset and 108 (2% of the total number of EEGs performed) were consistent with mTLE. Of the patients with electroencephalographic features of mTLE, only 27 (25%) had had MRI brain scans performed according to an epilepsy surgery protocol. Of these, 6 exhibited MRI findings confirming mTLE, identifying them as potential surgical candidates. Over three years, 75% of patients with electroencephalographic evidence suggesting mTLE did not receive appropriate work-up for epilepsy surgery. Conclusion: Surgery, especially anterior temporal lobectomy, is widely acknowledged to be an efficacious and cost-effective intervention in patients with medically refractory mTLE. The findings of our study suggest that patients with mTLE are under-investigated for potential surgical management, and that epilepsy surgery is under-utilised in South Africa. These findings are in line with similar studies in both well-resourced and resourceconstrained countries. We hope that our study will highlight the utility of EEG as a screening tool to identify patients with drug-resistant epilepsy due to mTLE, who may be candidates for anterior temporal lobectomy. 2025-04-03T13:01:06Z 2025-04-03T13:01:06Z 2024 2025-04-03T12:51:49Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/41358 Eng application/pdf Department of Medicine Faculty of Health Sciences University of Cape town |
| spellingShingle | Medicine Soni, Aayesha Anterior temporal lobectomy. A cross-sectional observational study of potential surgical candidates at a single institute |
| thesis_degree_str | Master's |
| title | Anterior temporal lobectomy. A cross-sectional observational study of potential surgical candidates at a single institute |
| title_full | Anterior temporal lobectomy. A cross-sectional observational study of potential surgical candidates at a single institute |
| title_fullStr | Anterior temporal lobectomy. A cross-sectional observational study of potential surgical candidates at a single institute |
| title_full_unstemmed | Anterior temporal lobectomy. A cross-sectional observational study of potential surgical candidates at a single institute |
| title_short | Anterior temporal lobectomy. A cross-sectional observational study of potential surgical candidates at a single institute |
| title_sort | anterior temporal lobectomy a cross sectional observational study of potential surgical candidates at a single institute |
| topic | Medicine |
| url | http://hdl.handle.net/11427/41358 |
| work_keys_str_mv | AT soniaayesha anteriortemporallobectomyacrosssectionalobservationalstudyofpotentialsurgicalcandidatesatasingleinstitute |