Temporal lobectomy in patients with bitemporal epilepsy defined by depth electroencephalography

Area of Science:

• Neurosurgery
• Epileptology
• Clinical Neurology

Background:

• Temporal lobectomy is a common surgical treatment for refractory epilepsy.
• Patient selection is crucial for successful surgical outcomes.
• The precise percentage of seizures originating from the target lobe is a key consideration.

Purpose of the Study:

• To evaluate the efficacy of temporal lobectomy in patients with seizures originating independently from each temporal lobe.
• To determine if a lower percentage of seizures originating from the target lobe impacts surgical outcomes.
• To reassess the criteria for patient selection for temporal lobectomy.

Main Methods:

• Review of 23 patients with bilateral independent temporal lobe seizures identified by depth electroencephalography (EEG).
• Assessment of neuropsychological testing, interictal EEG, imaging, and subclinical seizures.
• Analysis of outcomes for 11 patients who underwent temporal lobectomy, considering seizure origin percentage.

Main Results:

• All 11 patients who underwent temporal lobectomy achieved significant seizure reduction.
• Nine patients became seizure-free, one had >75% reduction, and one had 50-75% reduction.
• Outcomes were similar between patients with <80% and ≥80% of seizures originating from the resected lobe.

Conclusions:

• Having fewer than 80% of seizures originate from one temporal lobe should not be an absolute contraindication for temporal lobectomy.
• Depth EEG is valuable in identifying independent temporal lobe seizure origins.
• Temporal lobectomy remains an effective treatment for selected patients with bilateral independent temporal lobe epilepsy.