SURGICAL-MANAGEMENT OF INDEPENDENT BIHEMISPHERIC SEIZURE FOCI

A combination of nonresective and minimally resective (NRMR) procedure s were used to treat a series of patients with intractable seizures wh o were poor candidates for conventional epilepsy surgery because of th eir independent bihemispheric seizure foci. Over the past 5 years, 10 patients with bihemispheric seizure foci have had seizure surgeries on both hemispheres and ha ire had postoperative follow-up for a minimum of 6 months. Preoperative investigations included magnetic resonance (MR) imaging, positron emission tomography (PET) scanning, and video-E EG monitoring with surface and subdural electrodes. Multiple subpial c ortical transection (MST) was the primary procedure in all 10 patients . Following MST, 8 patients had minimal cortical resection (topectomy) in areas that continued to show epileptiform discharges in prolonged trains on intraoperative corticography. In addition, stereotactic amyg dalohippocampotomy was performed on 2 patients. The longest follow-up is 62 months, with a median of 16 months. Five patients are free of se izures; 3 have rare seizures; 1 has >90% reduction in seizure frequenc y; and I has complete cessation of myoclonic seizures with >50% reduct ion in frequency of complex partial seizures. There were no complicati ons from any of the procedures. The results indicate that seizures ori ginating from both hemispheres can be effectively and safely controlle d by a combination of surgical procedures. (C) 1997 by Elsevier Scienc e Inc. All rights reserved.