Patients with epileptic seizures and cerebral lesions who underwent lesionectomy restricted to or associated with the adjacent irritative area.
OBJECTIVE
To analyze the best surgical procedure for patients with epileptic seizures and cerebral lesions-i.e., resection restricted to the lesion or resection associated with the adjacent irritative area-based on the clinical evolution of patients' seizure outcome and electroencephalographic (EEG) and electrocorticographic (ECoG) findings.


METHODS
This study comprised 37 patients with epileptic seizures and cerebral lesions, ranging in age from 9 to 66 years. Patients were divided into two groups: Group 1 consisted of 21 patients with medically intractable epilepsy, Group 2 of 16 patients with medically controlled epilepsy. Eleven of the 21 patients in Group 1 (Subgroup A) underwent surgical resection of the cerebral lesion and adjacent irritative area as shown by ECoG. For the remaining 10 patients in Group 1 (Subgroup B), the resection was restricted to the lesion. The 16 patients in Group 2 all underwent lesionectomies.


RESULTS
Of the 11 patients in group 1 who underwent resection of the cerebral lesion and adjacent irritative area, 91% became seizure free. Sixty percent of the remaining patients in group I whose resections were restricted to the lesion also became seizure free, as did all the patients in group 2. An overall analysis of the EEGs for all patients showed a statistically significant decrease in paroxysmal activity.


CONCLUSIONS
In patients with uncontrolled seizures, resection of the cerebral lesion associated with the irritative area shows a tendency to obtain better seizure-outcome results than restricted lesionectomy.
Department of Neurology and Neurosurgery of the Federal University of São Paulo, Escola Paulista de Medicina, Brazil.
A
A
Rassi-Neto
F P
FP
Ferraz
C R
CR
Campos
F M
FM
Braga
D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D004569:Electroencephalography / Q000706:statistics & numerical data; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome