Practice parameter: temporal lobe and localized neocortical resections for epilepsy.
OBJECTIVE
To examine evidence for effectiveness of anteromesial temporal lobe and localized neocortical resections for disabling complex partial seizures.


METHODS
Systemic review and analysis of the literature since 1990.


RESULTS
One intention-to-treat Class I randomized controlled trial of surgery for mesial temporal lobe epilepsy found that 58% of patients randomized to be evaluated for surgical therapy (64% of those who received surgery) were free of disabling seizures and 10 to 15% were unimproved at the end of 1 year, compared with 8% free of disabling seizures in the group randomized to continued medical therapy. There was a significant improvement in quantitative quality-of-life scores and a trend toward better social function at the end of 1 year for patients in the surgical group, no surgical mortality, and infrequent morbidity. Twenty-four Class IV series of temporal lobe resections yielded essentially identical results. There are similar Class IV results for localized neocortical resections; no Class I or II studies are available.


CONCLUSIONS
A single Class I study and 24 Class IV studies indicate that the benefits of anteromesial temporal lobe resection for disabling complex partial seizures is greater than continued treatment with antiepileptic drugs, and the risks are at least comparable. For patients who are compromised by such seizures, referral to an epilepsy surgery center should be strongly considered. Further studies are needed to determine if neocortical seizures benefit from surgery, and whether early surgical intervention should be the treatment of choice for certain surgically remediable epileptic syndromes.
Engel
Jerome
J
Reed Neurological Research Center, Department of Neurology, Los Angeles, CA 90095-1769, USA. engel@ucla.edu
Wiebe
Samuel
S
French
Jacqueline
J
Sperling
Michael
M
Williamson
Peter
P
Spencer
Dennis
D
Gumnit
Robert
R
Zahn
Catherine
C
Westbrook
Edward
E
Enos
Bruce
B
D000927:Anticonvulsants / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D017029:Epilepsy, Complex Partial / Q000188:drug therapy / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D019579:Neocortex / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome
D000927:Anticonvulsants