[Surgical treatment of epilepsy caused by extensive brain damage]

An analysis of the clinical data on the intervention and results of treatment of 73 patients operated upon for epilepsy is reported, in whom resection was done of more than one cerebral lobe. They accounted for 17% of all patients treated surgically at this neurosurgical centre for seizures. A characteristic finding in this group was the presence of signs of severe brain damage, such as frequent and variegated seizures, neurological deficits, impairement of mental development, extensive EEG changes. In 50 patients resection of more than two lobes was done, in 22 cases three lobes were removed, and in 1 case even four lobes were removed. The operative mortality was 2.7%. The duration of follow up was 6 years, on the average. Forty-two per cent of the patients are without seizures, isolated seizures occurred in 16.5%, in 18% of cases the frequency of seizures was decreased, in 23.5% there was no improvement. Statistical analysis of the effects of certain elements of the clinical state on the final result of the treatment was carried out and it was found that a significant influence was exerted by: age below 20 years, occurrence of two or more types of seizures, and presence of generalized slow waves in EEG. In these patients the results were worse. On the other hand, the age of disease onset, disease duration, aetiology, intellectual level, changes in neuroradiological investigations, extent of resection were without effect on the final result of the treatment.