Abstracts

Frontal lobe is the largest lobe in the cerebral hemisphere, and has diverse functions spread on the widest surface area. Because of this, frontal lobe epilepsy is not well characterized compared with medial temporal lobe epilepsy. Our preoperative investigations are not different from other centers, and included EEG, interictal and ictal with video monitoring, and MRI basically. However, FDG-PET and SPECT were used more often in frontal lobe epilepsy than in other lobe origin epilepsies because cases without any apparent abnormalities in MR imaging were more common in frontal lobe epilepsy. Functional MR study was performed routinely to localize language and motor areas in most cases. Our epilepsy surgery program experienced 97 patients during the past 10 years. In order to localize ictal onset zone and functional areas, subdural electrodes were implanted in most patients (87/97). However, 3 out of these 87 patients could not undergo further surgical treatment because of poor localization of ictal onset zone. Once ictal onset zone localized, this zone was resected. In selected cases, callosotomy or multiple subpial transection was performed also. After a mean follow up of 55 months, 69% had more than worthwhile improvement including 43.5% seizure free rate. Frontal lobe epilepsy still imposes difficulties on surgical treatment, especially in cases of no apparent abnormalities in MR images. Recent progresses in neuroimaging field, to mention a few, MEG, DTI, etc, are expected to resolve these difficulties.