Abstracts

Rationale: Epilepsy surgery is a well established measure in pharmacoresistent focal epilepsy. There is a rate of seizure free patients after 1 year of 66% (Wiebe et al, N Engl J Med. 2001 Aug 2;345(5):311-8.). But there are very little data about long term seizure outcome exceeding two years (Schmidt et al, Epilepsy Res. 2004 Jul-Aug;60(2-3):187-201). We have analysed seizure outcome 10 years after epilepsy surgery in 50 patients with pharmacoresistent temporal lobe epilepsy (TLE).Methods: We analysed the records of all consecutivly operated patients with TLE, operated on before May 1997 with a minimum follow up (FU) of 10 years. FU visits were 3 month, 6 month and than every following year post op. The outcome was defined by the Engel-outcome classification and has been prospectively documented in the patient records.Results: The age range of 50 patients was between 9.8 and 58.2 years. 66% had a left sided, 34% a right sided TLE. The surgical approach was a modified very restricted temporal pole resection and amygdalo-hippocampectomy in mesio-temporal epilepsies and an extended lateral neocortical resection in temporo-lateral epilepsies. After 10 years FU (in 16 patients) there are still 69% patients in class I and additional 19 % patients in class II. There is a slight but not significant difference between mesio-temporal and temporo-lateral epilepsies and between left and right sided operated patients. Also, in some patients, there was a shift between the classes during the 10 year period.Conclusions: We report about an excellent seizure outcome 10 years after surgical intervention in TLE. This outcome is due to careful patient selection which considers the morphology, the occurrence of bilateral interictal discharges and the spread of seizure pattern to the contralateral side.