Multiple subpial transection for control of epileptic seizures: effectiveness and safety.
OBJECTIVE
To assess the efficacy and safety of multiple subpial transection (MST), a new technique in epilepsy surgery, alone and in combination with resection.


METHODS
MST was performed in 22 patients with intractable epilepsy, 10 of whom were treated with a combination of a resection and MST in functionally important cortex, 6 of whom were treated with a combination of a resection and MST performed outside functionally important cortex, and 6 of whom were treated with MST alone.


RESULTS
Of the 6 patients who received MST alone, none became seizure free and 4 showed > 50% reduction of all seizure types. In 2 patients, including 1 with Rasmussen's encephalitis, no change in seizure frequency or intensity occurred. Of the 16 patients in whom MST was combined with a resection, 9 (56%) became seizure free. Six of the remaining 7 patients showed > 95% reduction of all seizure types. Disappearance of epileptiform potentials in the postoperative EEG correlated significantly with complete relief from seizures. Subtle, permanent neurological deficits remained in 5 of 14 patients who received MST in functionally important brain areas.


CONCLUSIONS
Reduction of the seizure frequency was substantial in 4 of 6 patients who received MST alone, but complete seizure control was not observed. MST surrounding a lesionectomy may be a new surgical approach which would minimize the excised volume and improve seizure control.
Hufnagel
A
A
Department of Epileptology, University of Bonn, Germany.
Zentner
J
J
Fernandez
G
G
Wolf
H K
HK
Schramm
J
J
Elger
C E
CE
D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery*; D002648:Child; D004827:Epilepsy / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D005625:Frontal Lobe / Q000473:pathology / Q000601:surgery; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000601:surgery; D010296:Parietal Lobe / Q000473:pathology / Q000601:surgery; D010841:Pia Mater / Q000601:surgery; D016896:Treatment Outcome