Abstracts

RATIONALE: Head trauma is one cause of intractable epilepsy in which surgical treatment is often not successful. Evaluation of the clinical factors surrounding posttraumatic epilepsy may help predict surgical outcome. METHODS: During a 10 year period we identified 27 patients who underwent focal resective surgery for intractable epilepsy secondary to head trauma. Preoperative evaluation included MRI, WADA and neuropsychologic testing, and EEG-video monitoring with both scalp and intracranial electrodes when indicated. Postoperative follow-up varied from 6 months to 10 year. Data included severity of head injury as defined by Annegers et al. (Neurology, 1980), age at head trauma, localization of seizure focus, and outcome of surgery (Engel's classification, with class I & II considered good outcome). RESULTS: Only 13/27 patients experienced a good outcome after surgery. Good outcome correlated with less severe head trauma (8/10 with mild trauma versus 5/17 with moderate to severe head trauma). A younger age at the time of head trauma also seemed to carry a better chance of good outcome (5/7 who were 5 years of age or younger at time of trauma, compared to 8/20 whose trauma occurred later in life). There was a trend for better outcome when the resection was of an isolated mesial temporal focus (8/12 did well) compared with patients having lateral temporal or extra temporal resections (7/15 showed improvement). CONCLUSIONS: Posttraumatic epilepsy has a less than 50% cure rate with surgery. Factors predicting better success are a mild injury occurring early in life, and an isolated mesial temporal lobe focus.