Abstracts

Rationale: Epilepsy surgery is an effective option for the patients with medication refractory temporal lobe epilepsy. Earlier studies showed that careful selection of potential candidates can improve their long-term outcomes. Methods: We analyzed patients undergoing presurgical evaluation and epilepsy surgery at the University Hospital in Croatia. Preoperative evaluation included detailed clinical history, long-term video-electroencephalography, brain 1.5 or 3T MRI with epilepsy protocol, interictal PET/CT scan and neuropsychological testing. Collected demographic and clinical data included patients' age, age of epilepsy onset, duration of epilepsy, age at surgery, seizure frequency rate, presurgical evaluation data, pathohistology of resected specimen and post-surgical outcomes. All patients had failed at least 2-3 antiepileptic drugs and had a minimum of monthly seizure rates. Seizure outcome was based on the modified Engel scale. Results: Epilepsy surgery program at our University Hospital started in November 2009. Since then we performed, on average, 2-3 epilepsy surgeries each month. Mean age of patients at the time of surgery was 32 years, 60% were females and mean duration of epilepsy was 22 years. All subjects had full concordance between interictal and ictal video-EEG data, MRI, PET and memory evaluation. Hippocampal sclerosis was identified with MRI investigations and confirmed in pathological resections in 86% of patients, oligodendroglioma in 1 patient, and a cystic malformation in the temporal lobe in 1 patient. Eighty-six percent of patients had a selective amigdalohippocampectomy, 61.5% on the left side. Ninety-three percent of patients had a satisfactory seizure outcome (Engel 1 and 2). Transient neurological complications occurred in 1 patient (sensory dysphasia) and surgical complications occurred in 1 patient (haemorrhage), but without permanent sequelae. Conclusions: We present the first epilepsy surgery for refractory temporal lobe epilepsy results from Croatia. Seizure-free rates and outcomes are similar to those reported in other studies.