SURGICAL-TREATMENT OF INTRACTABLE SEIZURES WITH MULTILOBAR OR BIHEMISPHERIC SEIZURE FOCI (MLBHSF)

BACKGROUND Patients with multilobar or bihemispheric seizure foci (MLB HSF) are generally not considered candidates for major resective surge ry because of the high risk of complications. A combination of relativ ely less invasive surgical procedures were used to treat 19 patients w ith intractable seizures with MLBHSF. METHODS Epileptogenic areas were identified via standard techniques. Locations of the seizure foci wer e in two lobes of a hemisphere in 11 patients, three lobes of a hemisp here in four patients, four lobes of a hemisphere in one patient, and both hemispheres in three patients. All 19 patients had multiple subpi al transections; in addition, seven patients had small topectomies and nine patients had amygdala hippocampotomies. RESULTS The longest foll ow-up is 54 months and the median for follow-up is 33 months. Nine pat ients (47%) are either free of seizures or have only rare seizures; ei ght patients (41%) have greater than 90% reduction in seizure frequenc y; one patient (6%) has complete cessation of myoclonic seizures and s econdary generalization, and greater than 50% reduction in partial com plex seizures; and one patient (6%) has greater than 50% reduction in seizure frequency. There were no permanent operative complications. CO NCLUSION Though the follow-up is relatively short and the number of pa tients is small, these results are encouraging, because the majority o f patients in this group were poor surgical candidates. (C) 1997 by El sevier Science Inc.