Surgery of epilepsy in Switzerland - With particular reference to the Zurich series of selective amygdalohippocampectomy

Epilepsy surgery in Switzerland dates back to 1949. At present it is a well -tried treatment option for certain patients suffering from surgically reme diable epilepsy syndromes, such as the syndrome of mesial temporal lobe epi lepsy, and is "booming" not only in Switzerland. Possible reasons for this "boom" include the availability of advanced non-invasive diagnostic tools t o delineate epileptogenic lesions and epilepsy-related functional deficits. Improved electrophysiological and surgical techniques are, however, equall y important. All these improvements result in better postsurgical outcomes and a larger proportion of refractory patients are benefited by surgical th erapy. The important role of epilepsy surgery in modern neuroscience is als o acknowledged. There is a growing need for quality control and for multidi sciplinary and multinational collaboration. Following a brief review on the diagnostic methods and types of epilepsy surgery we report on the seizure outcome of patients who underwent selective amygdalohippocampectomy (sAHE) performed in Zurich since 1975. The series consists of 430 patients. Suffic iently precise follow-up data were available for 353 patients. The mean fol low-up of the patients was 7.5 years (min/max=1/20.5). The last available s eizure outcome was classified according to Engel: I, seizure free; II, Fare seizures; III, worthwhile improvement; IV, no worthwhile improvement. 237 patients (67 %) belonged to outcome category 1; 35 patients (10%) to outcom e category II; 56 patients (16%) to outcome category ill; and 25 patients ( 7%) to outcome category IV. Compared to the follow-up assessed in 1994, the most recent longterm follow-up data are even more favourable. The favourab le postoperative seizure outcome data of our patients, in particular the st able year-to-year group data for category I. are evidence of the validity o f the sAHE procedure developed in Zurich for surgical treatment of drug-res istant mesial temporal robe epilepsy.