Surgical treatment of multifocal epilepsy involving eloquent cortex.
OBJECTIVE
This report describes our long-term follow-up for combined resective surgery and multiple subpial transections (MSTs) in patients with refractory epilepsy involving eloquent and noneloquent cortex in multiple lobes. Multiple independent seizure foci made these patients poor candidates for conventional surgery.


METHODS
MST and resective surgery were used in 13 patients to treat localization-related refractory epilepsy involving eloquent and noneloquent cortex of two or more lobes. Preoperative investigation was followed by invasive monitoring.


RESULTS
Eleven patients had MST plus resection involving two different lobes, and two patients had MST plus resection involving three different lobes. MSTs were performed on the primary sensorimotor cortex (eight patients), temporal language area (two patients), Broca's area (one patient), and on both frontal motor and temporal language areas (two patients). Nine patients had a two-stage procedure, and four patients had a three-stage procedure (two consecutive subdural grid studies followed by resections). Average follow-up was 59.2 months (range, 42-98 months). With a modified Engel Outcome Scale, four patients (31%) had a class I outcome; three (23%), class II; three (23%), class III; and three (23%), class IV. Ten (77%) patients had a >50% reduction of seizure burden.


CONCLUSIONS
Combined MST and resection can meaningfully improve seizure control in patients with multifocal epilepsy involving eloquent cortex. Prospective randomized studies are needed.
Devinsky
Orrin
O
Department of Neurology, New York University, New York, NY, USA. od4@nyu.edu
Romanelli
Pantaleo
P
Orbach
Darren
D
Pacia
Steven
S
Doyle
Werner
W
D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003337:Corpus Callosum / Q000503:physiopathology / Q000601:surgery*; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D010841:Pia Mater / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D012189:Retrospective Studies