Surgical outcome of epilepsy patients evaluated with a noninvasive protocol

Surgery is now an accepted treatment for some medically intractable epileps ies. Presurgical evaluation is particularly important for the localization of the epileptogenic zone, which may necessitate sophisticated imaging tech niques and intracranial electroencephalogram (EEG) recordings. If patients are carefully selected, however, successful results can be achieved with no ninvasive evaluation methods. Seventy-seven patients were operated on for i ntractable seizures. All patients underwent EEG, neuropsychological, psychi atric, and magnetic resonance imaging investigations. Ictal EEG-video recor ding was performed in all nonlesional and in some lesional cases that had d iscordant data. Selective amygdalo-hippocampectomy was performed on patient s with mesial temporal lobe epilepsy (MTLE), an extended or a limited lesio nectomy was performed on patients with structural lesions, and a lesionecto my with deafferentation was performed on two patients with West syndrome. E lectrocorticography was not used. Temporal lobe directed surgery was perfor med in 63.6% of the cases. The pathological examinations of all cases showe d hippocampal sclerosis (HS) in 43%, tumor or tumor-like lesions in 36%, an d cortical dysplasia in 5% of patients. After a mean follow-up of 17 months (range, 2-53), 75% of the patients were seizure-free with or without aura and 15% had a marked improvement, whereas 10% did not benefit from surgery. Neuropsychological outcome of patients with MTLE and I-IS also showed wort hwhile results. Our patients, who were evaluated without pre- and periopera tive intracranial recordings and other sophisticated techniques, had an out come comparable to those in other series from more experienced centers. Our experience indicates that successful results, especially for patients with MTLE-HS and lesion-related epilepsies, can be obtained at centers with lim ited resources if the diagnoses and evaluation procedures are performed car efully.