[Pharmacoresistant temporal epilepsy: surgical treatment and analysis of factors influencing on its results].
An objective of the study is an analysis of the results of surgical treatment and influence of resection volume on the treatment outcome. Sixty-four patients, aged 7-46 years, with an epileptic focus in a temporal lobe have been studied. Patients have been stratified into 2 groups. The first group included 55 patients with epileptogenic lesions of a temporal lobe (monoregional lesions) and the second one--9 patients who, along with the lesion of one temporal lobe, had the signs of lesions in other brain areas (multiregional lesions). In the group of patients with monoregional lesions, a resection of the affected area has been performed. In other patients, the techniques of resection of frontal-medial temporal lobe regions within the scope of the area of steady epileptiform activity have been used. The results have been assessed with the modified Engel scale: class I--an absence of clinically manifested seizures (auras are possible); class II--seizures that do not impact quality of life; class III--a decrease of seizures frequency by more than 80%; class IV--an absence of substantial improvement. In the monoregional lesions, the satisfactory results (I-II classes) were observed in 39 patients (74%), including outcomes of class I (28 patients). In other 16 cases outcomes of classes III and IV were observed. In the multiregional lesions and cryptogenic (possibly symptomatic) partial epilepsy, outcomes of classes III and IV were observed in all patients, regardless of the resection volume. In conclusion, the highest efficacy with regard to frequency and severity of seizures is achieved by resections including the whole area of visualized lesion and border-line area of steady epileptic activity, the identification of which demands the intrasurgery neurophysiologic study. In the extensive and multiregional lesions, the resection surgery confined to one temporal lobe has low effect.
Konovalov
A N
AN
Gusev
E I
EI
Gekht
A B
AB
Stepanenko
A Iu
AIu
Arkhipova
N A
NA
Pronin
I N
IN
Lubnin
A Iu
AIu
Buklina
S B
SB
Shishkina
L V
LV
Lebedeva
A V
AV
Ariasova
I K
IK
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000494:pharmacology*; D002648:Child; D004351:Drug Resistance; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D000927:Anticonvulsants