Surgical effects of focus resection for patients with intractable epilepsy

Postoperative seizure-free outcome, psychiatric condition, intellectual function, and employment status were reviewed to demonstrate the usefulness of focus resection in 71 patients who underwent resective epilepsy surgery between 2000 and 2010 for the treatment of medication-resistant epilepsy. The psychiatric problems were assumed to be present only if the patient received psychotropic drug therapy. Seizure-free outcome was obtained in 53 (75%) patients. The patients were followed up for 2.0-12.0 years (mean 7.2 years) after surgery. Temporal lobe epilepsy (TLE), late seizure onset, short seizure duration, and magnetic resonance imaging lesions were all significantly associated with cessation of seizures. Psychotropic drug therapy was performed in 3 (4.2%) patients before surgery and in 12 (17.0%) patients at 2 years or later after surgery. TLE and preoperative psychotropic drugs were significantly associated with postoperative psychiatric problems. Among the 71 patients, 65 underwent full Wechsler Adult Intelligence Scale-Revised (WAIS-R) examinations both before and after surgery. The mean WAIS-R score was 82.5 ± 18.7 points for total intelligence quotient (IQ) preoperatively and 89.6 ± 20.3 points for total IQ postoperatively. Before surgery, 19 (27%) patients were engaged in full-time employment. After surgery, 2 patients lost and 9 patients newly entered full-time employment, so a total of 26 (37%) patients were engaged in full-time employment after surgery. Resective epilepsy surgery resulted in overall improvements in seizure control, intellectual functions, and employment status. However, patients with TLE had some risk of postoperative psychiatric disorder.