Surgical outcome in patients with epilepsy and dual pathology

Citation
Lm. Li et al., Surgical outcome in patients with epilepsy and dual pathology, BRAIN, 122, 1999, pp. 799-805
Citations number
36
Categorie Soggetti
Neurology,"Neurosciences & Behavoir
Journal title
BRAIN
ISSN journal
00068950 → ACNP
Volume
122
Year of publication
1999
Part
5
Pages
799 - 805
Database
ISI
SICI code
0006-8950(199905)122:<799:SOIPWE>2.0.ZU;2-4
Abstract
High-resolution MRI: can detect dual pathology tan extrahippocampal lesion plus hippocampal atrophy in about 5-20% of patients with refractory partial epilepsy referred for surgical evaluation. We report the results of 41 sur gical interventions in 38 adults (mean age 31 years, range 14-63 years) wit h dual pathology, Three patients had two operations. The mean postoperative follow-up was 37 months (range 12-180 months). The extrahippocampal lesion s were cortical dysgenesis in 15, tumour in 10, contusion/infarct in eight and vascular malformation in five patients. The surgical approach aimed to remove what was considered to be the most epileptogenic lesion, and the 41 operations were classified into lesionectomy (removal of an extrahippocampa l lesion); mesial temporal resection (removal of an atrophic hippocampus); and lesionectomy plus mesial temporal resection (removal of both the lesion and the atrophic hippocampus), Lesionectomy plus mesial temporal resection resulted in complete freedom from seizures in 11/15 (73 %) patients, while only 2/10 (20%) patients who had mesial temporal resection alone and 2/16 (12.5%) who had a lesionectomy alone were seizure-free (P < 0.001), When cl asses I and II were considered together results improved to 86, 30 and 31%, respectively. Our findings indicate that in patients with dual pathology r emoval of both the lesion and the atrophic hippocampus is the best surgical approach and should be considered whenever possible.