Abstracts

Rationale: Management of patients with epilepsy is multidisciplinary and multifaceted. Despite advances in medical management of epilepsy, it is clear that the role of neurosurgical intervention in this field is tantamount. Standard temporal lobectomy and its minimally invasive alternative approach, selective amygdalohippocampectomy (SAH), have become an integral part of the surgical treatment paradigm involved in the management of mesial temporal sclerosis. This study examines the outcomes after standard temporal lobectomy and SAH at the University of Southern California, which consists of a large public and private academic setting. Methods: We reviewed our series of patients with medically intractable epilepsy who were treated with standard temporal lobectomy or SAH and were performed by a single surgeon. From 2004-2013, 131 patients were surgically treated for medically intractable temporal lobe epilepsy at LAC/USC Medical Center and Keck Medical Center of USC. A retrospective analysis was conducted on patients who had completed a 5 year post-operative follow up. The remainder of the patients are still undergoing analysis. Results: Fifty patients that had long-term follow up of at least 5 years were included in the data analysis. The rate of seizure cure after surgical intervention was classified according to International League Against Epilepsy classification. Our analysis revealed that 69.2% of patients were completely seizure free with no auras, 11.5% patients had 1 to 3 seizure days per year with or without auras, and 19.2% of patients had 1 to 4 seizure days per year or a 50% seizure reduction per year with or without auras. Favorable seizure outcomes in the clinical setting were defined as at least 50% reduction in seizures post operatively. There were no documented deaths secondary to surgical invention. Conclusions: Our experience at USC with standard temporal lobectomy and SAH in the treatment of medically intractable epilepsy has been a favorable one. Almost 70% of our patient population was seizure-free after surgical intervention. Moreover, the overall seizure burden decreased dramatically at 5 years post surgery for all 50 patients who underwent surgical intervention. It remains clear that standard temporal lobectomy or SAH is a safe and well-tolerated primary or adjunctive treatment in the surgical management of epilepsy