Bitemporal intractable epilepsy: could it be surgically treatable?.
BACKGROUND
The goal of this study is to retrieve the attention to the treatment opportunities for this cohort of intractable bitemporal epilepsy patients who in most cases are not considered optimal candidates for surgery.


OBJECTIVE
The purpose of this study is to demonstrate that electrophysiologically guided precise surgeries on both temporal lobes can have a beneficial effect on seizures without additional cognitive decline.


METHODS
Twenty-one intractable bitemporal epilepsy patients [13 men, 8 women, mean age 21 years (range 6-43), mean duration of illness 17 years (range 3-31), frequency of seizures 6-55 per month] underwent stereotactic cryosurgery on both temporal lobes guided by chronic and intraoperative depth electrode studies.


RESULTS
Class I ('free of disabling seizures') outcome was achieved for 11/21 (52%), class II ('rare seizures') for 6/21 (29%), and class IV ('no worthwhile improvement') for 4/21 (19%) patients. No worsening of seizure or clinically significant cognitive or memory impairments were observed in this cohort of patients (follow-up 5-10 years).


CONCLUSIONS
The minimally invasive precise surgeries on both temporal lobes confined to the removal/lesion of just the brain tissue that exhibited epileptic activity can have a beneficial effect on seizure frequency and severity without additional devastating declines in intelligence, learning and memory.
Department of Functional Neurosurgery, Epilepsy Surgery Center, The Saradzhishvili Institute of Clinical and Experimental Neurology, Tbilisi, Georgia. sozari@neurology.bsd.uchicago.edu
Sozari A
SA
Chkhenkeli
Miron
M
Šramka
Tamas N
TN
Rakviashvili
George S
GS
Lortkipanidze
George E
GE
Magalashvili
Eteri Sh
ESh
Bregvadze
Alexander
A
Otarashvili
Tamar Sh
TSh
Gagoshidze
D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D004569:Electroencephalography / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D013702:Temporal Lobe / Q000473:pathology / Q000502:physiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult