Beyond pharmacotherapy: surgical management.
OBJECTIVE
To review the recent advances in the field of temporal lobe epilepsy (TLE) surgery.


RESULTS
TLE surgery has recently demonstrated a highly significant superiority over optimal medical therapy in a randomized trial. Accordingly, a median rate of 70% of class I outcome (patients free of disabling seizures postoperatively) has emerged from the pooling of all data published since the early 1990s. In addition, successful TLE surgery appears likely to reduce the risk of seizure-related death. However, it remains largely underused and overly delayed, partly because of the legitimate fears of possible surgical complications, such as verbal memory deficits or failure to control seizures. Reasons for surgical failures are not completely understood, and include bitemporal, pseudotemporal, and temporal-plus epilepsies, as well as insufficient resection of the mesial temporal structures. Developing techniques such as intraoperative MRI, gamma-knife radiosurgery, and various types of cranial nerves or intracerebral chronic stimulation have the potential to alleviate part of the limitations of TLE surgery.


CONCLUSIONS
The overall benefit of surgical treatment in patients with drug-resistant TLE should encourage a more frequent and earlier referral of such patients to epilepsy surgery centers. Important progress toward higher rates of seizure-free outcome and lower morbidity remains to be made and may be obtained by taking advantage of the new available technologies.
Ryvlin
Philippe
P
Department of Functional Neurology and Epileptology, CERMEP, Unit 31, Neurological Hospital, 59 boulevard Pinel, 69003 Lyon, France. ryvlin@cermep.fr
D038481:Anterior Temporal Lobectomy / Q000379:methods*; D000927:Anticonvulsants / Q000627:therapeutic use; D004351:Drug Resistance; D004599:Electric Stimulation Therapy / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D011788:Quality of Life; D016634:Radiosurgery / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome
D000927:Anticonvulsants