RESECTION SURGERY FOR PARTIAL EPILEPSY - RELATION OF SURGICAL OUTCOMEWITH SOME ASPECTS OF THE EPILEPTOGENIC PROCESS AND SURGICAL APPROACH

In spite of the progressive improvement of the results of resective su rgery for epilepsy, the number of not significantly benefited patients remains high. An attempt was made to find out a relation between outc ome and some aspects of the pathophysiological organization of the epi leptogenic process and of the surgical procedure. Chi-square and logis tic regression statistic analyses were utilized. The study was retrosp ectively performed on 138 surgically treated patients having a minimum follow-up of three years. Three classes of surgical outcome were cons idered: completely seizure free (including aura; 86 cases, 62.3%), sig nificant seizure reduction (31 cases, 22.5%), and no significant impro vement (21 cases, 15.2%). What follows was brought into evidence by th e study. 1) On the diagnostic side, the spatial arrangement (focal, un ilateral, multifocal) of both the interictal and the ictal epileptic e lectrocerebral activities are significantly associated with the surgic al outcome. Their relative impact on outcome is related to the presenc e of a structural lesion: when a lesion is documented, the interictal activity has the higher value; vice versa, when no lesion is apparent, the role of the ictal activity is prevalent. However, the presence, a s well as the nature of the lesion, per se, are not significantly asso ciated with outcome. 2) On the surgical side, the extent of resection of both the structural lesion and of the epileptogenic zone are highly associated with the surgical result; the extent of lesion resection p revails on that of the epileptogenic zone. The type of surgical approa ch (hemispherectomy: 17 cases; temporal lobectomy: 67 cases; extratemp oral resection: 54 cases) has no significant relation to the outcome. The value and the limits of the results obtained are discussed.