Abstracts

Rationale: Epilepsy surgery is an accepted and appropriate treatment for localization-related intractable epilepsy. A variety of obstacles to performing epilepsy surgery and the necessary work-up can be encountered in a large metropolitan public hospital. We report the outcomes of patients with mesial temporal sclerosis (MTS) who underwent standard temporal lobectomy with the same surgeon (CL) at the Los Angeles County/University of Southern California (USC) Medical Center, as part of the larger USC Comprehensive Adult Epilepsy Program. Methods: A retrospective chart review was conducted of nineteen patients who underwent surgery from June 2004 through January 2008. All patients had MRI evidence of MTS, concordant unilateral temporal seizure onsets, and passed a WADA test prior to surgery. Data were collected from the time of surgery to the most recent out-patient follow-up. Results: Two of the nineteen patients (11%) were lost to follow-up. Of the 17 patients who continued follow up in our Epilepsy clinic, the average number of years of epilepsy pre-operatively was 29.9, with a range of 15-51 years. The average number of AED’s pre-operatively was 2.47 (range 1-4), compared to the number of AED’s post operative: 1.76 (range 0-3). The average patient age at surgery was 37.7 years, and 10 of 17 (59%) were women. Fourteen of the 17 patients (82%) were of Hispanic descent, ten of those 14 (71%) considered Spanish their primary language. Thirteen of the 17 (76%) were seizure-free (Engel Class I), 3 (18%) had rare seizures (Engel Class II) identified as due to non-compliance with anti-epileptic drugs (AED’s), and one patient continued to have rare seizures until leviteracetam was added, then became seizure-free. Overall, the percentage of patients achieving Engel Classification I or II was 100%. The average post-op follow-up was twenty-one months (range 4-44 months). Conclusions: Potential obstacles to epilepsy care can be overcome in a large metropolitan public hospital. These obstacles may include delay of care, delay of work-up necessary for epilepsy surgery, and lack of surgical options in the treatment of epilepsy. Hispanic patients, and particularly women, are less likely to undergo epilepsy surgery. We outline here a small but culturally distinct population of patients with longstanding epilepsy (>15 years) who have had good outcomes from epilepsy surgery. This study demonstrates that there is a high likelihood for seizure freedom and an opportunity to reduce AED load, even in a setting lacking cultural acceptance of surgery and long delays in care. Given these good surgical outcomes, we believe that culturally sensitive education of patients and their families in a comprehensive epilepsy center may improve the care of epilepsy patients.