title: Surgical treatment of parietal lobe epilepsy.
abstract: OBJECTIVE
  Parietal lobe epilepsy (PLE) accounts for a small percentage of extratemporal epilepsies, and only a few and mostly smaller series have been reported. Preoperative findings, surgical strategies, pathological bases, and postoperative outcomes for PLE remain to be elucidated.
  
  
  METHODS
  Patients with PLE were identified by screening a prospective epilepsy surgery database established in 1989 at the University of Bonn. Charts, preoperative imaging studies, surgical reports, and neuropathological findings were reviewed. Seizure outcome was classified according to Engel class (I-IV).
  
  
  RESULTS
  Forty patients (23 females and 17 males) with PLE were identified and had a mean age of 25.0 years and a mean preoperative epilepsy duration of 13.7 years. Nine patients had a significant medical history (for example, trauma, meningitis/encephalitis, or perinatal hypoxia). Preoperative MR imaging abnormalities were identified in 38 (95%) of 40 patients; 26 patients (65%) underwent invasive electroencephalography evaluation. After lesionectomy of the dominant (in 20 patients) or nondominant (in 20 patients) parietal lobe and additional multiple subpial transections (in 11 patients), 2 patients suffered from surgical and 12 from neurological complications, including temporary partial Gerstmann syndrome. There were no deaths. Histopathological analysis revealed 16 low-grade tumors, 11 cortical dysplasias, 9 gliotic scars, 2 cavernous vascular malformations, and 1 granulomatous inflammation. In 1 case, no histopathological diagnosis could be made. After a mean follow-up of 45 months, 27 patients (67.5%) became seizure free or had rare seizures (57.5% Engel Class I; 10% Engel Class II; 27.5% Engel Class III; and 5% Engel Class IV).
  
  
  CONCLUSIONS
  Parietal lobe epilepsy is an infrequent cause of extratemporal epilepsy. Satisfactory results (Engel Classes I and II) were obtained in 67.5% of patients in our series. A temporary partial hemisensory or Gerstmann syndrome occurs in a significant number of patients.
authors.affiliation: Department of Neurological Surgery, University of California, Irvine, California, USA. dbinder@uci.edu
authors.forename: Devin K
authors.initials: DK
authors.lastname: Binder
authors.forename: Martin
authors.initials: M
authors.lastname: Podlogar
authors.forename: Hans
authors.initials: H
authors.lastname: Clusmann
authors.forename: Christian
authors.initials: C
authors.lastname: Bien
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.forename: Johannes
authors.initials: J
authors.lastname: Schramm
authors.forename: Thomas
authors.initials: T
authors.lastname: Kral
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D005260:Female; D005862:Gerstmann Syndrome / Q000453:epidemiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010296:Parietal Lobe; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014741:Video Recording; D055815:Young Adult