Breaking the Seizure Cycle: Surgical Outcomes of Medial Temporal Lobectomy in Drug-Resistant Epilepsy

Medial temporal lobe (MTL) lesions are among the most common causes of drug-resistant epilepsy. Surgical management typically involves lesion excision, with or without amygdalohippocampectomy. An alternative approach includes selective hippocampal transection to disrupt the epileptogenic circuit without affecting the memory circuit. Objective: To assess epilepsy control after medial temporal lobectomy for management of drug-resistant temporal lobe epileptic patients.

This is a prospective cohort interventional study of consecutive series of patients coming to Al-Azhar University Hospitals at the time between 2022 and 2024 presented with drug-resistant temporal lobe epilepsy (TLE) and treated with excision of the lesions in the MTL with or without amygdalohippocampectomy. Postoperative seizure control was assessed using the Engel classification scale during follow-up and anti-epileptic drug (AED) withdrawal.

The Engel classification scale was used at follow-up and AED withdrawal to evaluate postoperative seizure control. The results indicated that seizure control improved after medial temporal lobectomy. The final follow-up showed that 15 respondents (75%) reached Engel class I which means they had no seizures and five respondents (25%) had Engel class II, which means they had rare, non-disabling seizures. These results show that medial temporal lobectomy is effective in reducing seizure frequency and improving the quality of life of patients.

A medial temporal lobectomy, alone or in combination with amygdalohippocampectomy, serves as an effective surgical treatment for drug-resistant TLE. Most patients experience both a reduction in seizure frequency and severity while seizure freedom occurs in the majority after the procedure. These results support surgical management as an essential treatment option for medically refractory epilepsy and highlight the importance of identifying patients for early surgical evaluation. More studies with bigger sample sizes along with extended follow-up periods should be performed to improve patient selection criteria and surgical methods that enhance patient outcomes.