Long-Term Operative Outcome in Patients with Pharmacoresistant Localization-Related Epilepsy.
Abstract number :
2.281
Submission category :
Year :
2001
Submission ID :
1653
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
D.M. Cambier, MD, Neurology, Ohio State University, Columbus, OH; G.D. Cascino, MD, Neurology, Mayo Clinic, Rochester, MN; W.R. Marsh, MD, Neurosurgery, Mayo Clinic, Rochester, MN; F.B. Meyer, MD, Neurosurgery, Mayo Clinic, Rochester, MN; F.W. Sharbrough,
RATIONALE: To investigate the long-term operative outcome in a consecutive series of patients who underwent a focal corticectomy for intractable partial epilepsy at one institution.
METHODS: We performed a retrospective analysis of seizure outcome in 526 patients surgically treated at Mayo Clinic, Rochester, MN predominantly between 1988-1996. All patients had medically refractory partial seizures. The mean age at surgery was 32 years (3-69). The mean age at seizure onset was 13 years (0-65). The standardized preoperative evaluation consisted of routine EEG recordings, inpatient video-EEG monitoring, MRI head seizure protocol, neuropsychological testing, visual perimetry and a sodium amobarbital study.
RESULTS: Four hundred and seventy nine patients (91.1%) had a temporal lobe resection and 28 patients (5.3%) had a frontal lobe resection. The mean duration of follow-up was 2 years. The surgical pathology included: gliosis (n=240), MTS (n=118), tumor (n=50), vascular malformation (n=16), and focal cortical dysplasia(n=16). The long-term operative outcome could be determined for 507 patients: Class I 342 patients (67.5%), Class II 31 patients (6.1%), Class III 37 patients (7.3%), and Class IV 97 patients (19.1%). Identification of hippocampal formation atrophy, unilateral temporal lobe spikes, or a temporal lobe lesional pathology were favorable predictors of operative outcome(p[lt] 0.05). Thirteen patients (2.4%)experienced a transient or persistent operative adverse effect. The cause of death in 7 patients who died during follow-up was status epilepticus.
CONCLUSIONS: Surgery is an effective and safe treatment for patients with intractable partial epilepsy. The majority of patients during long-term follow-up will continue to experience a significant reduction in seizure tendency. The present study may prove useful in counseling patients being considered for epilepsy surgery.
Support: Mayo Foundation.