Abstracts

Rationale: Surgical treatment of medically-refractory partial epilepsy has been shown to be associated with better outcomes than medication alone in appropriately-selected patients. With advances in pre-surgical procedures, we sought to determine our outcomes following epilepsy surgery for refractory partial epilepsy. Methods: Combined data from noninvasive measures including interictal/ictal scalp EEG, MRI, and PET were utilized to identify epileptogenic zones. When noninvasive methods produced insufficient or inconclusive data, intracranial EEG monitoring wer performed. This data was prospectively entered into a clinical database. We queried this database, and reviewed all epilepsy surgeries from 1993 - 2011 at our tertiary care facility. Data from 155 patients who underwent surgical treatment were included in the study. Outcome data was reported from a period at or beyond 1 - 3years after surgery, using the Engel criteria. Patients with malignant neoplasms and lack of sufficient outcomes were excluded. For our review we collected surgical outcomes and pathologies of our patients. Results: Of the 150 patients, 110 (73.3%) were temporal lobe resections (TLR), 25 (16.7%) were extratemporal resections (ETR), 6 (4.0%) were callosotomies,and 9 (6.0%) were multiple subpial transections (MSR). Of the 110 temporal lobe epilepsy cases 75(68.2%) were seizure free (Engel 1), and 21 (19.1%) showed improvement (Engel 2, 3). Of the 25 extratemporal cases, 12 (48.0%) were seizure free (Engel 1), while 13 (52.0%) showed improvement (Engel 2, 3).Of the 155 patients 31 (20%) of the patients had definite mesial temporal sclerosis, 51 (32.9%) had mild gliosis, 26 (17.0%) had a cortical dysplasia or heterotropia, and 14 (9.0%) had a benign neoplasm. Conclusions: Our data confirms that in appropriately-selected patients with medically-refractory partial epilepsy, surgical treatment is associated with good outcomes in a majority of cases. Our data concludes that surgical intervention for refractory partial epilepsy effective.