Epilepsy surgery in Belgium, the Flemish experience

Area of Science:

• Neurosurgery
• Epileptology
• Clinical Neurology

Background:

• Medically refractory epilepsy poses significant challenges for patient quality of life.
• Comprehensive presurgical evaluation is crucial for identifying surgical candidates.
• Epilepsy surgery offers a potential therapeutic alternative for intractable seizures.

Purpose of the Study:

• To evaluate the efficacy of presurgical evaluation and epilepsy surgery for medically refractory epilepsy.
• To assess seizure control and quality of life outcomes post-surgery.
• To identify factors influencing surgical success in epilepsy patients.

Main Methods:

• 160 patients underwent comprehensive presurgical evaluation including video-EEG monitoring, neuro-imaging (CT, MRI), and neuropsychological testing.
• 27 patients underwent invasive monitoring with intracranial electrodes.
• 40 patients ultimately underwent surgical procedures such as temporal lobectomy, lesionectomy, or callosotomy.

Main Results:

• 39 out of 40 surgical patients had detectable structural abnormalities, frequently in the temporal lobe.
• Excellent seizure control (seizure-free) was achieved in 27 patients (67.5%) after a mean follow-up of 20 months.
• Overall quality of life substantially improved in patients with seizure freedom or significant seizure reduction.

Conclusions:

• Comprehensive presurgical evaluation and epilepsy surgery are effective for medically refractory epilepsy.
• Surgical intervention leads to significant seizure reduction and improved quality of life.
• Epilepsy surgery is a labor-intensive but rewarding therapeutic option for selected patients.