SUCCESSFUL EPILEPSY SURGERY WITHOUT INTRACRANIAL EEG RECORDING - CRITERIA FOR PATIENT SELECTION

Twenty-two patients with intractable complex partial seizures (CPS) we re treated with temporal lobectomy. Eighteen of 22 (82%) are seizure-f ree while receiving medication, with a mean follow-up time of 4 years. In each case, the clinical seizure pattern, interictal and ictal scal p EEG, magnetic resonance imaging (MRI), neuropsychological testing, a nd results of the intracarotid amobarbital procedure (IAP) converged t o indicate a localized abnormality. None of the patients in this serie s had mass lesions, vascular malformations, or cortical scars, but 18 of 22 had hippocampal atrophy on MRI and 20 had hippocampal sclerosis (HS) on pathologic examination. We believe it is possible, on the basi s of the preoperative evaluation described, to identify a population o f epileptic patients who will do very well postoperatively. Such patie nts do not require invasive EEG monitoring, and they represent similar to 20% of the patients treated surgically in our epilepsy unit in the past several years.