[On the best strategies on the best results for surgery of frontal epilepsy].
Frontal lobe epilepsy surgery is the second most common surgery performed for drug-resistant partial epilepsy. We investigated the longitudinal outcome in a cohort of patients investigated since 1990 with SEEG and modern diagnostic techniques. We reviewed 105 patients who underwent surgery between 1990 and 2005 (mean follow-up, six years; range: one to 17 years) and analyzed the year-per-year follow-up according to Engel's classification. Favorable outcome (Class I) was observed for 70% and this result was stable at least five years after surgery. More than 90% of patients with lesion-related epilepsies (focal cortical dysplasia and dysembryoplastic neuroepithelial tumors) became seizure-free. Less than 50% of patients classified as having cryptogenic epilepsy (defined as normal imaging and neuropathology on surgical specimen) had a favorable outcome. Permanent neurological sequelae were subtle and rare, especially after surgery for dysplasia in eloquent cortex (primary motor cortex). Our data indicate that frontal surgery is a successful treatment in patients when electrophysiological and morphological investigations demonstrate a well-defined epileptogenic zone or lesion to be surgically resected. Progress in electrophysiological and brain-imaging techniques will further improve the selection of frontal lobe epilepsy surgery candidates.
Trottier
S
S
Service de neurochirurgie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France. suzanne.trottier.fr
Landré
E
E
Biraben
A
A
Chassoux
F
F
Pasnicu
A
A
Scarabin
J-M
JM
Turak
B
B
Devaux
B
B
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography; D004594:Electrophysiology; D017034:Epilepsy, Frontal Lobe / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000473:pathology; D019635:Neurosurgical Procedures / Q000379:methods; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D012640:Seizures / Q000453:epidemiology / Q000503:physiopathology; D016896:Treatment Outcome