Late results of operation in temporal lobe epilepsy in adults and children

In our clinic at the Medical Academy in Warsaw 282 patients with temporal lobe epilepsy were treated surgically. The causes of the illness were trauma in 43.2%, including birth trauma in 19.5%, infections diseases in early life in 19.8%, and microtumours in 6.8%. In 30% the aetiology was unknown. Fifty per cent had fits before 10 years and 75% before 20 years of age. The period of conservative treatment was on average nine years. Serial and stereo-EEG recordings including activation by ketamine, as well as intracarotid sodium amytal tests were performed routinely. The interictal EEG epileptiform abnormalities were found most frequently in both temporal lobes (154 cases). The operation was carried out according to Penfield's technique, with electrocorticography and resection of the temporal lobe extending for 6 to 10 cm in the nondominant hemisphere and for 4 to 5 cm in the dominant hemisphere using suction technique. In 75% microscopical changes in the hippocampus were found, in 20% so-called hamartomas and in 6.8% small gliomas. Two patients died and in 13 patients there was a hemiparesis which was transient in 10. The authors present the analysis of late results of 262 cases with a follow-up from 2 to 22 years after operation. Very good results were obtained in 127 cases (48.5%) - no attacks since leaving the clinic. Good results were observed in 42 patients (16%) - not more than 1-2 attacks a year. Thus, the operation resulted in freedom from attacks, or nearly so, in 169 cases (64.5%). In an additional 47 patients (18%) there was a significant reduction (at least 50%) in seizures without complete freedom from attacks, and in 44 cases (16.8%) no improvement was observed. The analysis of our series suggests that the best results may be obtained in patients with unilateral temporal EEG changes. The existence of an additional focus in parts of the other temporal lobe does not impair the operative results when the dominant epileptic focus has been removed. Among 24 cases with equally pronounced bitemporal EEG abnormalities the stereo-EEG studies allowed detection of the epileptic focus in 13 patients (54%). Detailed analysis of the results, obtained in 51 children below 15 years of age, led to the conclusion that temporal lobe epilepsy should be operated upon even in young children, provided that the epileptic focus can be clearly identified.