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The nature history of untreated epilepsy in rural areas in Tibetan areas
Abstracts / Journal of the Neurological Sciences 333 (2013) e1–e64
leading to low penetrance of BBB and more drug resistance. Of inflammatory cytokines, IL-1β during seizure group was significantly higher than that in each group. But CPR during seizure group was significantly lower than that in epileptic subjects but not in control subjects. Further studies are needed to support this hypothesis. doi:10.1016/j.jns.2013.07.201
Abstract — WCN 2013 No: 2905 Topic: 1 — Epilepsy Early seizures in patients with acute ischemic stroke S.-J. Lee. Neurology, Yeungnam University, Daegu, Republic of Korea Background: The aim of this study is to establish the incidence of acute post-ischemic stroke seizures and to determine risk factors associated with early seizures in acute ischemic stroke. Patients and methods: A total of 1370 consecutive patients with acute infarction were included. Onset seizures and early seizures were defined as seizures occurring within 24 h and 7 days from the onset of infarction, respectively. Patients with high fever, previous history of epilepsy, and metabolic encephalopathy were excluded. Results: Eleven patients (0.8%) developed early seizures after acute infarction; and 6 patients (55%) had onset seizures. TOAST classification of the stroke among those patients was large artery disease in 4 (36%), cardio-embolism in 3 (27%), vasculitis in 1 (9%), and cryptogenic stroke in 3 cases (27%). All of the 11 patients developed generalized tonic and/ or clonic seizures. All patients had cortical involvement with various size of the lesions; large in 3 (27%), moderate in 5 (45%), and small lesions in 3 (27%). There were 2 cases of hemorrhagic transformation of the lesions. Conclusions: Since all patients had cortical lesions, the most important factor of early seizures may be the location of lesions. Patients with lacunar and infratentorial infarctions did not develop early seizures. Patients with onset seizures had more seizures during acute stage than those without onset seizure. doi:10.1016/j.jns.2013.07.202
Abstract — WCN 2013 No: 2944 Topic: 1 — Epilepsy Usefulness of PET/CT in diagnosis of temporal epilepsy J. Mączewskaa, A. Ryszb, P. Palczewskic, M. Kobyleckaa, K. FronczewskaWieniawskaa, W. Grajkowskad, E. Matyjad, L. Królickia, A. Marchelb, A. Cieszanowskic. aNuclear Medicine Department, Warsaw Medical University, Warsaw, Poland; bNeurosurgery Clinic, Warsaw Medical University, Warsaw, Poland; cDepartment of Clinical Radiology, Warsaw Medical University, Warsaw, Poland; dDepartment of Pathology, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland Aim: The aim of this study was to assess the usefulness of routine 18F FDG PET/CT examination in patients with temporal lobe epilepsy before surgery. Material and methods: 41 patients with medically refractory temporal lobe epilepsy (21 women and 20 men, age 31 ± 9) underwent interictal PET/CT examination approximately 30 min post-i.v. injection of 250 MBq 18F FDG and contrast enhanced brain MRI. All patients underwent surgery (temporal lobe with hippocampus resection). The diagnosis was verified by histopathology. PET and MRI were assessed by two independent physicians, who were blinded to clinical signs and results of EEG. Results: In 34/41 (83%) of patients in PET/CT areas of hypometabolism including mesial temporal lobe, that correlated with histopathology,
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were observed. Pathologies were present in 18/41 (43%) of patients in MRI. In 2 patients hypometabolism was observed in both mesial temporal lobes without lateralization of changes. In 1 patient area of hypometabolism was present in the contralateral temporal lobe, there was no pathology in MRI. In 4/41 (10%) of patients there was no pathology in PET/CT and MRI. Histopathologal findings included tumours (ganglioglioma, oligodendroglioma and DNET), focal cortical dysplasia (FCD) type IB, FCD IIA, FCD IIIa and hippocampal sclerosis. There were no significant differences in FDG accumulation between these pathologies. Conclusions: 18F FDG PET/CT shows markedly more often abnormal tracer distribution that could correspond to epileptogenic foci than MRI. doi:10.1016/j.jns.2013.07.203
Abstract — WCN 2013 No: 2924 Topic: 1 — Epilepsy Insights gained through the China demonstration project — practical experience from Sichuan D. Zhou, J. Mu, L. Liu, Q. Zhang, J. Li, Y. Si. Neurology Department, Sichuan University, Chengdu, China Epilepsy is affecting 50 million people in the world, 85% of whom live in resource-poor countries. Epilepsy also imposes an enormous physical, psychological, social and economic burden on individuals, families and countries. In 1997, the Global Campaign Against Epilepsy was launched in China. As a part of the campaign, a demonstration project on epilepsy management was carried out in rural China, also in Sichuan in 2005. In the past 8 years, this project expanded to 9 countries and covered 4,937,000 populations in Sichuan province. 8128 patients were enrolled and 6547 received phenobarbital or sodium valproate treatment. After 8 years of follow-up, 79.8% of the patients had 50% or greater reduction in seizure frequency and 43.3% remained seizure free. The quality of life greatly improved in 72% patients. The treatment gap was successfully reduced to 13%. The main premature cause of death of epilepsy patients is accidental death (59%), especially drowning (45.1%) and then we did targeted prevention. We made the intervention package to enhance medical compliance and improve seizure control, which helped the proportion of patients with N50% seizure reduction to 79.8%. Besides, 837 physicians were efficiently trained to treat people with epilepsy. The most important, this project had successfully implemented a sustainable treatment and management model of epilepsy in rural areas. This project not only completed its basic aim in promoting education, training, and treatment for epilepsy patients in rural China, but also helped to find an operational model to sustain and success in management of chronic disease in resource-poor regions. doi:10.1016/j.jns.2013.07.204
Abstract — WCN 2013 No: 2960 Topic: 1 — Epilepsy The nature history of untreated epilepsy in rural areas in Tibetan areas J. Mua, L. Liua, Y. Zhaob, D. Zhoua, J. Wuc, S. Lid. aNeurology Department, Sichuan University, Chengdu, China; bNeurology Department, People's Hospital of Tibetan Autonomous Regions, Lhasa, China; cNeuroepidemiology Department, Beijing Neurosurgical Institute, Beijing, China; dChina Association Against Epilepsy (CAAE), Beijing, China
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Abstracts / Journal of the Neurological Sciences 333 (2013) e1–e64
Purpose: To evaluate the nature history of people with untreated prevalent epilepsy in rural Tibetan areas. Methods: During 2006 to 2010, we carried out a door to door epidemiologic community survey in a sample of 60,466 subjects in 5 rural counties in both Tibetan Autonomous Regions and Sichuan province. People with suspicious symptoms are investigated retrospectively, but only active epilepsy has been registered and followed up regularly and prospectively. Results: At the survey, we identified 473 (60.7% male) people with convulsive epilepsy, of whom 367 (61.9% male) were “active epilepsy” and followed up for mean 41 ± 8.6 months. In the retrospective survey, 22.4% patients with untreated become spontaneous remission for more than 5 years, 31.7% become spontaneous remission for more than 3 years, and 48.8% seizure free for only 1 year. During the follow-up, 79 (21.5%) patients were tried to treat by antiepileptic drug (AED), but only 34 continued the treatment for more than 3 years, 45 (12.3%) patients used traditional Tibetan medicine, and another 243 (66.2%) patients believe in God instead of AED. 12 (3.3%) subjects died. 174 patients are followed up more than 5 years, 48(27.6%) of them has spontaneous remission. For the 308 who were untreated and under treatment followed up, 96(31.2%) of them have spontaneous remission for 3 years. Besides, 55.9% (19/34) of those who take AED regularly have seizure free after 3 years of treatment. Conclusion: Spontaneous remission of epilepsy occurs in a portion of untreated patients. The AEDs do have an effect to elevate the rate of seizure free. doi:10.1016/j.jns.2013.07.205
Abstract — WCN 2013 No: 2974 Topic: 1 — Epilepsy Localization of focal delta activity in epilepsy patients after brain surgery using MEG H. Stefana, M. Schönherrb, S. Ramppb. aNeurological Clinic, University Hospital Erlangen, Erlangen, Germany; bNeurological Department, University Hospital Erlangen, Erlangen, Germany Background: In this study we introduce an automatic method for source localization of focal slowing demonstrating the relation between spikes and delta activity in 9 patients after previous brain surgery. Objective: In case of focal epilepsy, surgery can often improve seizure frequency in these pharmacoresistant patients. However, not all patients are completely seizure free thereafter. Residual epileptic activity which leads to persisting seizures can be localized by interictal spikes. Additionally slow wave brain activity can be used for focus localization. Patients and methods: Nine patients with pharmacoresistant epilepsy after brain surgery were examined using MEG. 20 min of spontaneous brain activity at rest were recorded and sources of delta and theta activities were localized with Dynamic Imaging of Coherent Sources (DICS, 5). Additionally interictal spike localization results were used for setting up a spherical region of interest (ROI) with a radius of 2 cm. Results: In 3/9 patients, the global maximum of the theta band hits the ROI, in another 3 patients it is the third or fourth local maximum, and in 3 patients no local maximum is found within the ROI at all. The localization results lie at the borders, not more than 2 cm away from the spikes. Conclusion: The results show a strong relation between interictal spikes and delta activity in patients after brain surgery. The method runs automatic, so it is user-independent and faster than visual inspection of data to find segments with slowing of brain activity. Supported by: DFG STE 580/15-1. doi:10.1016/j.jns.2013.07.206
Abstract — WCN 2013 No: 2978 Topic: 1 — Epilepsy Functioning and disability in patients with epilepsy: psychosocial difficulties reported by patients R. Quintasa, M. Cerniauskaitea, V. Covellia, A.M. Giovannettia, S. Schiavolina, A. Raggia, P. Meuccia, D. Sattina, M. Pagania, F. Villanib, G. Didatob, F. Deleob, S. Franceschettic, S. Binellic, L. Canafogliac, M. Casazzac, C. Sabariegod, M. Coenend, A. Ciezad,e, M. Leonardia. a Neurology, Public Health and Disability Unit, Clinical Neuroscience Department (DINEC), Italy; bNeurology VII Unit — Clinical Epileptology and Experimental Neurophysiology, Italy; cNeurology VI Unit — Neurophysiology and Diagnostic Epileptology, Neurological Institute Carlo Besta, IRCCS Foundation, Milan, Italy; dResearch Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Department of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-MaximiliansUniversity of Munich, Munich, Germany; eAcademic Unit Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK Background: Although the burden and associated psychosocial difficulties (PSDs) in persons with epilepsy (PwE) are known and recognized, there is not a comprehensive understanding of those difficulties and the factors that have an impact on them. Objective: This study aimed to identify and analyse psychosocial difficulties that adult PwE experience in everyday life, their changes and determinants. Patients and methods: 80 adult PwE (ICD-10: G40.1; G40.2 and G40.3) were interviewed using the EU project PARADISE Protocol. Results: Mean age of patients was 41 years, 50% were females, 53% were married, 70% had at least high school education, and 66% were working. Clinical rating of epilepsy severity was moderate or severe for 69% of PwE and on average patients took two antiepileptic drugs. PSDs more often reported by PwE were related to memory problems (58%), being emotionally affected by health condition (74%), anxiety (69%), depressive symptoms (66%), problems at work (55%), driving problems (60%), and restlessness (80%). Half of the sample reported that PSDs got better in time in comparison with the previous years while 27% considered that there was no change. Main determinants acting as moderate or strong environmental barriers were sideeffects of medicines (59%) and lack of sensitivity towards PwE (52%). Conclusions: People with epilepsy as main respondents reported their PSDs. Perceived improvement of difficulties over time and identified determinants that have impact on PSDs suggest that it is important to consider environment's impact on health and disability when planning personalised care programmes for PwE. doi:10.1016/j.jns.2013.07.207
Abstract — WCN 2013 No: 2985 Topic: 1 — Epilepsy Imaging memory in temporal lobe epilepsy: reorganisation of verbal and visual memory function following anterior temporal lobe resection S. Bonellia,b, P. Thompsonb, M. Yogarajahb, R. Powellb, R. Samsonb, A. McEvoyc, M. Symmsb, M. Koeppb, J. Duncanb. aNeurology, Medical University of Vienna, Vienna, Austria; bClinical and Experimental Epilepsy, UCL Institute of Neurology, UK; cNeurosurgery, National Hospital for Neurology and Neurosurgery, London, UK Background: Anterior temporal lobe resection (ATLR) controls seizures in 70% of patients with intractable temporal lobe epilepsy
leading to low penetrance of BBB and more drug resistance. Of inflammatory cytokines, IL-1β during seizure group was significantly higher than that in each group. But CPR during seizure group was significantly lower than that in epileptic subjects but not in control subjects. Further studies are needed to support this hypothesis. doi:10.1016/j.jns.2013.07.201
Abstract — WCN 2013 No: 2905 Topic: 1 — Epilepsy Early seizures in patients with acute ischemic stroke S.-J. Lee. Neurology, Yeungnam University, Daegu, Republic of Korea Background: The aim of this study is to establish the incidence of acute post-ischemic stroke seizures and to determine risk factors associated with early seizures in acute ischemic stroke. Patients and methods: A total of 1370 consecutive patients with acute infarction were included. Onset seizures and early seizures were defined as seizures occurring within 24 h and 7 days from the onset of infarction, respectively. Patients with high fever, previous history of epilepsy, and metabolic encephalopathy were excluded. Results: Eleven patients (0.8%) developed early seizures after acute infarction; and 6 patients (55%) had onset seizures. TOAST classification of the stroke among those patients was large artery disease in 4 (36%), cardio-embolism in 3 (27%), vasculitis in 1 (9%), and cryptogenic stroke in 3 cases (27%). All of the 11 patients developed generalized tonic and/ or clonic seizures. All patients had cortical involvement with various size of the lesions; large in 3 (27%), moderate in 5 (45%), and small lesions in 3 (27%). There were 2 cases of hemorrhagic transformation of the lesions. Conclusions: Since all patients had cortical lesions, the most important factor of early seizures may be the location of lesions. Patients with lacunar and infratentorial infarctions did not develop early seizures. Patients with onset seizures had more seizures during acute stage than those without onset seizure. doi:10.1016/j.jns.2013.07.202
Abstract — WCN 2013 No: 2944 Topic: 1 — Epilepsy Usefulness of PET/CT in diagnosis of temporal epilepsy J. Mączewskaa, A. Ryszb, P. Palczewskic, M. Kobyleckaa, K. FronczewskaWieniawskaa, W. Grajkowskad, E. Matyjad, L. Królickia, A. Marchelb, A. Cieszanowskic. aNuclear Medicine Department, Warsaw Medical University, Warsaw, Poland; bNeurosurgery Clinic, Warsaw Medical University, Warsaw, Poland; cDepartment of Clinical Radiology, Warsaw Medical University, Warsaw, Poland; dDepartment of Pathology, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland Aim: The aim of this study was to assess the usefulness of routine 18F FDG PET/CT examination in patients with temporal lobe epilepsy before surgery. Material and methods: 41 patients with medically refractory temporal lobe epilepsy (21 women and 20 men, age 31 ± 9) underwent interictal PET/CT examination approximately 30 min post-i.v. injection of 250 MBq 18F FDG and contrast enhanced brain MRI. All patients underwent surgery (temporal lobe with hippocampus resection). The diagnosis was verified by histopathology. PET and MRI were assessed by two independent physicians, who were blinded to clinical signs and results of EEG. Results: In 34/41 (83%) of patients in PET/CT areas of hypometabolism including mesial temporal lobe, that correlated with histopathology,
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were observed. Pathologies were present in 18/41 (43%) of patients in MRI. In 2 patients hypometabolism was observed in both mesial temporal lobes without lateralization of changes. In 1 patient area of hypometabolism was present in the contralateral temporal lobe, there was no pathology in MRI. In 4/41 (10%) of patients there was no pathology in PET/CT and MRI. Histopathologal findings included tumours (ganglioglioma, oligodendroglioma and DNET), focal cortical dysplasia (FCD) type IB, FCD IIA, FCD IIIa and hippocampal sclerosis. There were no significant differences in FDG accumulation between these pathologies. Conclusions: 18F FDG PET/CT shows markedly more often abnormal tracer distribution that could correspond to epileptogenic foci than MRI. doi:10.1016/j.jns.2013.07.203
Abstract — WCN 2013 No: 2924 Topic: 1 — Epilepsy Insights gained through the China demonstration project — practical experience from Sichuan D. Zhou, J. Mu, L. Liu, Q. Zhang, J. Li, Y. Si. Neurology Department, Sichuan University, Chengdu, China Epilepsy is affecting 50 million people in the world, 85% of whom live in resource-poor countries. Epilepsy also imposes an enormous physical, psychological, social and economic burden on individuals, families and countries. In 1997, the Global Campaign Against Epilepsy was launched in China. As a part of the campaign, a demonstration project on epilepsy management was carried out in rural China, also in Sichuan in 2005. In the past 8 years, this project expanded to 9 countries and covered 4,937,000 populations in Sichuan province. 8128 patients were enrolled and 6547 received phenobarbital or sodium valproate treatment. After 8 years of follow-up, 79.8% of the patients had 50% or greater reduction in seizure frequency and 43.3% remained seizure free. The quality of life greatly improved in 72% patients. The treatment gap was successfully reduced to 13%. The main premature cause of death of epilepsy patients is accidental death (59%), especially drowning (45.1%) and then we did targeted prevention. We made the intervention package to enhance medical compliance and improve seizure control, which helped the proportion of patients with N50% seizure reduction to 79.8%. Besides, 837 physicians were efficiently trained to treat people with epilepsy. The most important, this project had successfully implemented a sustainable treatment and management model of epilepsy in rural areas. This project not only completed its basic aim in promoting education, training, and treatment for epilepsy patients in rural China, but also helped to find an operational model to sustain and success in management of chronic disease in resource-poor regions. doi:10.1016/j.jns.2013.07.204
Abstract — WCN 2013 No: 2960 Topic: 1 — Epilepsy The nature history of untreated epilepsy in rural areas in Tibetan areas J. Mua, L. Liua, Y. Zhaob, D. Zhoua, J. Wuc, S. Lid. aNeurology Department, Sichuan University, Chengdu, China; bNeurology Department, People's Hospital of Tibetan Autonomous Regions, Lhasa, China; cNeuroepidemiology Department, Beijing Neurosurgical Institute, Beijing, China; dChina Association Against Epilepsy (CAAE), Beijing, China
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Abstracts / Journal of the Neurological Sciences 333 (2013) e1–e64
Purpose: To evaluate the nature history of people with untreated prevalent epilepsy in rural Tibetan areas. Methods: During 2006 to 2010, we carried out a door to door epidemiologic community survey in a sample of 60,466 subjects in 5 rural counties in both Tibetan Autonomous Regions and Sichuan province. People with suspicious symptoms are investigated retrospectively, but only active epilepsy has been registered and followed up regularly and prospectively. Results: At the survey, we identified 473 (60.7% male) people with convulsive epilepsy, of whom 367 (61.9% male) were “active epilepsy” and followed up for mean 41 ± 8.6 months. In the retrospective survey, 22.4% patients with untreated become spontaneous remission for more than 5 years, 31.7% become spontaneous remission for more than 3 years, and 48.8% seizure free for only 1 year. During the follow-up, 79 (21.5%) patients were tried to treat by antiepileptic drug (AED), but only 34 continued the treatment for more than 3 years, 45 (12.3%) patients used traditional Tibetan medicine, and another 243 (66.2%) patients believe in God instead of AED. 12 (3.3%) subjects died. 174 patients are followed up more than 5 years, 48(27.6%) of them has spontaneous remission. For the 308 who were untreated and under treatment followed up, 96(31.2%) of them have spontaneous remission for 3 years. Besides, 55.9% (19/34) of those who take AED regularly have seizure free after 3 years of treatment. Conclusion: Spontaneous remission of epilepsy occurs in a portion of untreated patients. The AEDs do have an effect to elevate the rate of seizure free. doi:10.1016/j.jns.2013.07.205
Abstract — WCN 2013 No: 2974 Topic: 1 — Epilepsy Localization of focal delta activity in epilepsy patients after brain surgery using MEG H. Stefana, M. Schönherrb, S. Ramppb. aNeurological Clinic, University Hospital Erlangen, Erlangen, Germany; bNeurological Department, University Hospital Erlangen, Erlangen, Germany Background: In this study we introduce an automatic method for source localization of focal slowing demonstrating the relation between spikes and delta activity in 9 patients after previous brain surgery. Objective: In case of focal epilepsy, surgery can often improve seizure frequency in these pharmacoresistant patients. However, not all patients are completely seizure free thereafter. Residual epileptic activity which leads to persisting seizures can be localized by interictal spikes. Additionally slow wave brain activity can be used for focus localization. Patients and methods: Nine patients with pharmacoresistant epilepsy after brain surgery were examined using MEG. 20 min of spontaneous brain activity at rest were recorded and sources of delta and theta activities were localized with Dynamic Imaging of Coherent Sources (DICS, 5). Additionally interictal spike localization results were used for setting up a spherical region of interest (ROI) with a radius of 2 cm. Results: In 3/9 patients, the global maximum of the theta band hits the ROI, in another 3 patients it is the third or fourth local maximum, and in 3 patients no local maximum is found within the ROI at all. The localization results lie at the borders, not more than 2 cm away from the spikes. Conclusion: The results show a strong relation between interictal spikes and delta activity in patients after brain surgery. The method runs automatic, so it is user-independent and faster than visual inspection of data to find segments with slowing of brain activity. Supported by: DFG STE 580/15-1. doi:10.1016/j.jns.2013.07.206
Abstract — WCN 2013 No: 2978 Topic: 1 — Epilepsy Functioning and disability in patients with epilepsy: psychosocial difficulties reported by patients R. Quintasa, M. Cerniauskaitea, V. Covellia, A.M. Giovannettia, S. Schiavolina, A. Raggia, P. Meuccia, D. Sattina, M. Pagania, F. Villanib, G. Didatob, F. Deleob, S. Franceschettic, S. Binellic, L. Canafogliac, M. Casazzac, C. Sabariegod, M. Coenend, A. Ciezad,e, M. Leonardia. a Neurology, Public Health and Disability Unit, Clinical Neuroscience Department (DINEC), Italy; bNeurology VII Unit — Clinical Epileptology and Experimental Neurophysiology, Italy; cNeurology VI Unit — Neurophysiology and Diagnostic Epileptology, Neurological Institute Carlo Besta, IRCCS Foundation, Milan, Italy; dResearch Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Department of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-MaximiliansUniversity of Munich, Munich, Germany; eAcademic Unit Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK Background: Although the burden and associated psychosocial difficulties (PSDs) in persons with epilepsy (PwE) are known and recognized, there is not a comprehensive understanding of those difficulties and the factors that have an impact on them. Objective: This study aimed to identify and analyse psychosocial difficulties that adult PwE experience in everyday life, their changes and determinants. Patients and methods: 80 adult PwE (ICD-10: G40.1; G40.2 and G40.3) were interviewed using the EU project PARADISE Protocol. Results: Mean age of patients was 41 years, 50% were females, 53% were married, 70% had at least high school education, and 66% were working. Clinical rating of epilepsy severity was moderate or severe for 69% of PwE and on average patients took two antiepileptic drugs. PSDs more often reported by PwE were related to memory problems (58%), being emotionally affected by health condition (74%), anxiety (69%), depressive symptoms (66%), problems at work (55%), driving problems (60%), and restlessness (80%). Half of the sample reported that PSDs got better in time in comparison with the previous years while 27% considered that there was no change. Main determinants acting as moderate or strong environmental barriers were sideeffects of medicines (59%) and lack of sensitivity towards PwE (52%). Conclusions: People with epilepsy as main respondents reported their PSDs. Perceived improvement of difficulties over time and identified determinants that have impact on PSDs suggest that it is important to consider environment's impact on health and disability when planning personalised care programmes for PwE. doi:10.1016/j.jns.2013.07.207
Abstract — WCN 2013 No: 2985 Topic: 1 — Epilepsy Imaging memory in temporal lobe epilepsy: reorganisation of verbal and visual memory function following anterior temporal lobe resection S. Bonellia,b, P. Thompsonb, M. Yogarajahb, R. Powellb, R. Samsonb, A. McEvoyc, M. Symmsb, M. Koeppb, J. Duncanb. aNeurology, Medical University of Vienna, Vienna, Austria; bClinical and Experimental Epilepsy, UCL Institute of Neurology, UK; cNeurosurgery, National Hospital for Neurology and Neurosurgery, London, UK Background: Anterior temporal lobe resection (ATLR) controls seizures in 70% of patients with intractable temporal lobe epilepsy