Central lobe epilepsy surgery - (functional) results and how to evaluate them.

Area of Science:

• Neurosurgery
• Epileptology
• Quality of Life Research

Background:

• Central lobe epilepsy (CLE) surgery, particularly in the pericentral area, raises concerns about inevitable functional deficits.
• Understanding patient perceptions of postsurgical functional outcomes is crucial for comprehensive care.

Purpose of the Study:

• To evaluate functional loss following central lobe epilepsy (CLE) surgery.
• To assess patient-reported outcomes and satisfaction after CLE surgery.
• To compare findings with existing literature on functional outcomes in epilepsy surgery.

Main Methods:

• A cohort of 22 people with epilepsy (PWE) undergoing CLE surgery (pre- and postcentral gyri) was studied.
• Functional outcomes were assessed using the AQoL-8D and Rivermead Mobility Index (RMI).
• A systematic literature review identified studies reporting functional outcomes after epilepsy surgery.

Main Results:

• 54.4% of patients experienced new functional loss postoperatively.
• Mean AQoL-8D and RMI scores indicated a slight decrease compared to general population norms.
• Despite deficits, 72.7% achieved seizure freedom (Engel class 1A), and all PWE reported satisfaction with the surgery.

Conclusions:

• Central lobe resections do not always lead to new neurological deficits; approximately half of patients remain without them.
• Patient satisfaction with CLE surgery can be high, even in the presence of functional deficits, highlighting the importance of patient perspective.
• Counseling for CLE surgery should incorporate these findings, acknowledging that patients may accept deficits for seizure control and improved quality of life.