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Updated: Nov 9, 2025

Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Epilepsy surgery in stroke-related epilepsy.
Miguel A Arévalo-Astrada1, Richard S McLachlan1, Ana Suller-Marti1
1Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario, Canada, N6A 5A5.
Seizures in stroke-related epilepsy (SRE) often originate in the mesial temporal region, not the stroke lesion itself. Effective surgical management requires thorough presurgical evaluation for optimal outcomes in drug-resistant SRE.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Stroke-related epilepsy (SRE) presents a significant challenge in clinical practice.
- Drug-resistant SRE necessitates advanced diagnostic and therapeutic strategies.
Purpose of the Study:
- To analyze the presurgical evaluation and surgical management of patients with drug-resistant SRE.
- To identify seizure onset patterns and treatment outcomes in this cohort.
Main Methods:
- Retrospective analysis of patients with SRE from January 2013 to January 2020.
- Inclusion of patients who underwent intracranial EEG (iEEG), resective surgery, or vagus nerve stimulation (VNS).
Main Results:
- 5% of patients undergoing epilepsy surgery had SRE.
- Ictal onset was frequently in the mesial temporal region (85%) or involved both stroke lesions and extra-lesional areas.
- 9 out of 10 patients undergoing resective surgery achieved Engel I or II outcomes.
Conclusions:
- Seizures in drug-resistant SRE often originate in the mesial temporal region, rather than solely within the stroke lesion.
- Comprehensive presurgical assessment and tailored surgical interventions yield favorable outcomes for SRE.
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