Free Article with CME: Seizure Types after Temporal Lobectomy

Background: Temporal lobectomy can lead to favorable seizure outcomes in medically-refractory temporal lobe epilepsy (TLE). Although most studies focus on seizure freedom after temporal lobectomy, less is known about seizure semiology in patients who “fail” surgery. Morbidity differs between seizure types that impair or spare consciousness. Among TLE patients with seizures after surgery, how does temporal lobectomy influence seizure type and frequency?

Objective: To characterize seizure types and frequencies before and after temporal lobectomy for TLE, including consciousness-sparing or consciousness-impairing seizures.

Methods: We performed a retrospective longitudinal cohort study examining patients undergoing temporal lobectomy for epilepsy at our institution from January 1995 to August 2010.

Results: Among 241 TLE patients who received temporal lobectomy, 174 (72.2%) patients achieved Engel class I outcome (free of disabling seizures), including 141 (58.5%) with complete seizure freedom. Overall seizure frequency in patients with persistent postoperative seizures decreased by 70% (P < .01), with larger reductions in consciousness-impairing seizures. While the number of patients experiencing consciousness-sparing simple partial seizures decreased by only 19% after surgery, the number of individuals having consciousness-impairing complex partial seizures and generalized tonic-clonic seizures diminished by 70% and 68%, respectively (P < .001). Simple partial seizure was the predominant seizure type in 19.1% vs 37.0% of patients preoperatively and postoperatively, respectively (P < .001). Favorable seizure outcome was predicted by a lack of generalized seizures preoperatively (odds ratio 1.74, 95% confidence interval 1.06-2.86, P < .5).

Conclusion: Given important clinical and mechanistic differences between seizures with or without impairment of consciousness, seizure type and frequency remain important considerations in epilepsy surgery.

From: Seizure Types and Frequency in Patients Who “Fail” Temporal Lobectomy for Intractable Epilepsy by Englot et al.

Free full text access.

SANS Neurosurgery members can earn CME credits from this article.

Combining the power of neurosurgery’s most popular online learning resource with its most influential peer-reviewed journal, SANS Neurosurgery offers subscribers the resources to stay ahead in the rapidly moving field. Test your knowledge and neurosurgical decision-making skills with questions pulled from each issue of Neurosurgery. This SANS product provides users with the latest pearls and constantly evolving information from the latest scientific neurosurgery articles.