title: [Pharmacoresistant epilepsy after craniocerebral injury].
abstract: BACKGROUND
  Posttraumatic epilepsy is one of the possible serious consequencies of both closed and open head injury with clinical manifestation months or years after surgery. In pharmacoresistant patients, surgical therapy should be considered.
  
  
  METHODS
  The study summarises the results of surgical treatment of pharmacoresistant posttraumatic epilepsy in a group of 13 patients (11 males and 2 females). Average age at the time of injury was 9.6 years in males and 8.8 years in females. The average number of seizures was 10.7-17 seizures/month preoperatively. Invasive EEG monitoring was required in 5 patients in whom non invasive or semiinvasive investigations failed to localize the epileptogenic zone adequately. Temporal lobe resections were performed in 4 patients, 4 patients underwent extratemporal resections and vagus nerve stimulation system was implanted in 5 patients.
  
  
  RESULTS
  Three patients (75%) after temporal resections became seizure free (Engel I) and in the remaining patient significant reduction of seizures was achieved (Engel III). There were 2 seizure free patients after extratemporal resections (50%) and significant reduction of seizure rates was achieved (Engel III) in the remaining two. One patient after vagus nerve stimulation met the criteria for > 90% response and there was a 50-90% seizure rate reduction in the remaining 4 patients (vagus nerve stimulation responder).
  
  
  CONCLUSIONS
  Although in limited group of patients the study confirms good results of surgical treatment of selected posttraumatic epilepsy patients--mainly temporal epilepsy patients and patients after vagus nerve stimulation. Meticulous presurgical evaluation including invasive encephalography in indicated patients is a precondition for surgical success.
authors: Neurochirurgická klinika LF MU a FN u sv. Anny v Brnĕ, Pekarská 53, Brno. jan.chrastina@fnusa.cz
authors: J
authors: J
authors: Chrastina
authors: Z
authors: Z
authors: Novák
authors: I
authors: I
authors: Ríha
authors: K
authors: K
authors: Ghallab
authors: L
authors: L
authors: Martinek
authors: M
authors: M
authors: Brázdil
mesh_terms: D002648:Child; D006259:Craniocerebral Trauma / Q000150:complications*; D004834:Epilepsy, Post-Traumatic / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male