title: Outcome of lesionectomy in medically refractory epilepsy due to non-mesial temporal sclerosis (non-MTS) lesions.
abstract: OBJECTIVE
  To analyze the seizure outcome of lesionectomy for refractory epilepsy secondary to non-mesial temporal sclerosis (non-MTS) lesions.
  
  
  METHODS
  Sixty-eight patients with non-MTS lesions (M:F=42:26; age at onset: 11.7±9.6 years; age at surgery: 21.1±9.4 years), who underwent lesionectomy for refractory epilepsy were analyzed. The age at onset, frequency/type of seizure, MRI findings, video-EEG, histopathology and Engel's grading at 1 year/last follow up were recorded.
  
  
  RESULTS
  The duration of epilepsy at surgery was 9.9±6.9 years. The location of lesions were: temporal: 41 (60.3%); frontal: 21 (30.9%); parietal: 6 (8.8%). The type of lesionectomies performed were temporal 41 (60.3%), extra-temporal: 25 (36.8%), temporo-frontal and temporo-parietal: 1 (1.5%) patient each. The histopathological diagnosis were neoplastic: 32 (47.1%), cortical dysplasia: 19 (27.9%), other focal lesions: 17 (25%). At mean follow up of 2.9±2.1 years (median: 2.6 years), outcome was - Engel's class I: 43 (63.2%), IIa: 14 (20.6%), III: 7 (10.3%), IV: 4 (5.9%). Good seizure control (Engel's class I/IIa) was achieved in 57 (83.8%) patients. The good prognostic markers included temporal seizures, extended lesionectomy and AEDs after surgery while poor prognostic marker was gliotic lesion on histopathology.
  
  
  CONCLUSIONS
  Following lesionectomy due to non-MTS lesions, seizure freedom (Engel I) was noted in about 63.2% of patients, which is comparable to other series and reiterates the effectiveness of lesionectomy for seizure control.
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Dhiman
authors.forename: Sudhanva
authors.initials: S
authors.lastname: Rao
authors.forename: Sanjib
authors.initials: S
authors.lastname: Sinha
authors.forename: Arivazhagan
authors.initials: A
authors.lastname: Arimappamagan
authors.forename: Anita
authors.initials: A
authors.lastname: Mahadevan
authors.forename: Rose Dawn
authors.initials: RD
authors.lastname: Bharath
authors.forename: Jitender
authors.initials: J
authors.lastname: Saini
authors.forename: R
authors.initials: R
authors.lastname: Jamuna
authors.forename: J
authors.initials: J
authors.lastname: Keshav Kumar
authors.forename: Shobhini L
authors.initials: SL
authors.lastname: Rao
authors.forename: Bangalore A
authors.initials: BA
authors.lastname: Chandramouli
authors.forename: Parthasarathy
authors.initials: P
authors.lastname: Satishchandra
authors.forename: Susarla K
authors.initials: SK
authors.lastname: Shankar
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000601:surgery; D005260:Female; D005911:Gliosis / Q000473:pathology / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D012598:Sclerosis; D012640:Seizures / Q000601:surgery; D013702:Temporal Lobe / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Epilepsy; Lesionectomy; Outcome; Refractory; Surgery