Abstracts

Despite careful selection of patients with unilateral MTS for temporal lobe resection, most centers report persistent seizures in 20-40 % of patients postoperatively. We reviewed records from 195 patients who had antero-mesial temporal resections for epilepsy surgery and identified 17 patients with suspected mesial temporal sclerosis by MRI and no other risk factors for seizures but had an Engel outcome Class of II-IV (15 Class II, 1 Class III, 1 Class IV). All patients had extensive presurgical evaluations that included angiogram /Wada, neuropsychological evaluation, noninvasive interictal and ictal scalp AV/EEG, and intracranial EEG(14 of 17) and were determined to be good temporal lobectomy candidates by a multidisciplinary team. We compared historical and presurgical data from this group to 20 consecutive class I outcome patients with MTS (control group). The mean age of onset at the time of first non-febrile seizure was 12 years (range, 6 months-31 years) and duration of epilepsy was 26 years (range, 6-47) for the study group. Mean age of seizure onset was 9 years (range 1-26) and duration of epilepsy was 21 years (range 4-38) for the control group. Mean age at time of surgery was 38 years (range, 12-65) for the study group and 30 years (range 14-43) for controls. Febrile seizures occurred in 5 of 17 patients (29%) compared with 11 of 20 (55%) of controls. These data suggest that older age at time of surgery, longer duration of epilepsy before surgery, and absence of febrile seizures may be associated with persistent seizures following antero-mesial temporal resection in otherwise well-selected MTS patients.