Surgical outcome in hippocampal sclerosis following selective amygdalo-hippocampectomy

Temporal lobe epilepsy is the most common form of intractable partial epilepsy in adults with hippocampal sclerosis accounting for the majority of cases. Selective amygdalo-hippocampectomy (SEAH) is suggested as a safe and effective surgical procedure with the advantage of a better cognitive outcome.

We prospectively documented 56 consecutive patients with medically refractory medial temporal lob epilepsy. Candidates for surgery were determined as those with characteristic clinical and imaging findings, ictal recordings, and neuropsychological evaluation. A standard SEAH was performed and hippocampal sclerosis was histologically confirmed.

In our study 76.7% of patients were classified as Engel I and 62.2% as ILAE I at their last follow up. Overall, at the last follow-up, 51.8% of patients were seizure-free since surgery (Engel 1a and ILAE 1a), 25% had stopped antiepileptic treatment, and another 52% had decreased either the dosage or number of antiepileptic drugs. 86.3% of the patients with abnormality on neurocognitive tasks showed improvement at the end of the 6 months post surgery.

SEAH is a safe and effective surgical procedure without the necessity of a larger resection and further invasive methods.