Practice parameter: Temporal lobe and localized neocortical resections for epilepsy

Abstract

Abstract-Objectives/Methods: To examine evidence for effectiveness of anteromesial temporal lobe and localized neocortical resections for disabling complex partial seizures by systematic review and analysis of the literature since 1990. Results: One intention-to-treat Class I randomized, controlled trial of surgery for mesial temporal lobe epilepsy found that 58% of patients randomized to be evaluated for surgical therapy (64% of those who received surgery) were free of disabling seizures and 10 to 15% were unimproved at the end of 1 year, compared with 8% free of disabling seizures in the group randomized to continued medical therapy. There was a significant improvement in quantitative quality-of-life scores and a trend toward better social function at the end of 1 year for patients in the surgical group, no surgical mortality, and infrequent morbidity. Twenty-four Class IV series of temporal lobe resections yielded essentially identical results. There are similar Class IV results for localized neocortical resections; no Class I or II studies are available. Conclusions: A single Class I study and 24 Class IV studies indicate that the benefits of anteromesial temporal lobe resection for disabling complex partial seizures is greater than continued treatment with antiepileptic drugs, and the risks are at least comparable. For patients who are compromised by such seizures, referral to an epilepsy surgery center should be strongly considered. Further studies are needed to determine if neocortical seizures benefit from surgery, and whether early surgical intervention should be the treatment of choice for certain surgically remediable epileptic syndromes.

Getting the best outcomes from epilepsy surgery

“…After a randomized trial of surgery for temporal lobe epilepsy (TLE) 2 reported 64% seizure freedom, surgery was recommended as the treatment of choice for drug‐resistant TLE 3. A subsequent trial of surgery for drug‐resistant TLE of <2 years reported 85% seizure freedom, and improved quality of life and socialization 4…”

Using machine learning to classify temporal lobe epilepsy based on diffusion MRI

“…This question is important since the treatment outcomes of TLE are variable and not completely predictable based on clinical data (Engel et al., 2003; Spencer et al., 2005); indicating that there are different TLE phenotypes that remain unidentified, but could be discerned based on imaging, if the type and the location of regular TLE abnormalities were better understood. In this study, we tested the hypothesis that microstructural abnormalities are present within a common pattern in most subjects with TLE.…”

Responsive Cortical Stimulation for the Treatment of Epilepsy

“…2,3 Surgery is an option for some patients. Although anterior temporal lobectomy in persons with mesial temporal sclerosis can achieve a 1-to 2-year remission in Յ85% of cases, 4 resection of a well-defined neocortical lesion achieves 1-year seizure remission in only 56%. In addition to the typical risks associated with a craniotomy and general anesthesia, complications of surgery may include memory, language, visual, sensory, or motor deficits.…”