Artikel
Surgical treatment for extratemporal epilepsy: results and prognostic factors
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Although surgery is a widely accepted option for the treatment of pharmacoresistant extratemporal epilepsy, it remains still challenging due to difficulties in defining the epileptogenic zone, which frequently encroaches upon areas of high functionality. It was the aim of this study to analyze clinical and epileptological results and to provide prognostic factors influencing the seizure outcome.
Method: This single-center study comprises a consecutive series of 184 patients, who underwent resective surgery for extratemporal epilepsy. Comprehensive data including preoperative diagnostic modalities, surgical treatment, histopathological evaluation, and clinical as well as epileptological outcome were analyzed with a particular focus on prognostic factors.
Results: Resective procedures were located as follows: frontal (n=77), parietal (n=21), occipital (n=13) and insular (n=12). In 59 cases resection included more than one lobe. Histological evaluation revealed focal cortical dysplasia (n=84), benign tumors (n=52), cavernomas (n=22) and gliosis (n=26). After a mean follow up of 35 months, 96 (48%) patients remained completely seizure free (ILAE 1), and 123 (67%) had favorable outcome (ILAE1-3). Temporary morbidity occurred in 26 cases (14%), while permanent morbidity was encountered in 46 cases (25%). There was no perioperative death. Resections including more than one lobe had higher complication rate as compared to circumscribed resections within one lobe (p=0.01). We found the following significant predictors for excellent seizure outcome: singular MRI lesion (p=0.017), complete resection of the lesion (p=0.001), lack of epilepsy typical potentials postoperatively (p=0.001), lower age at surgery (p=0.01) and shorter duration of epilepsy (p=0.04).
Conclusions: Surgical treatment of extratemporal epilepsy provides satisfying epileptological results with an acceptable morbidity. Best epileptological results can be achieved in younger patients with circumscribed MRI lesions, which can be completely resected. Therefore, surgery should be kept in mind as an option for the treatment of pharmacoresistant extratemporal epilepsy especially in the young age.