Long-term surgical results of supplementary motor area epilepsy surgery.
OBJECTIVE Supplementary motor area (SMA) epilepsy is a well-known clinical condition; however, long-term surgical outcome reports are scarce and correspond to small series or isolated case reports. The aim of this study is to present the surgical results of SMA epilepsy patients treated at 2 reference centers in Mexico City. METHODS For this retrospective descriptive study (1999-2014), 52 patients underwent lesionectomy and/or corticectomy of the SMA that was guided by electrocorticography (ECoG). The clinical, neurophysiological, neuroimaging, and pathological findings are described. The Engel scale was used to classify surgical outcome. Descriptive statistics, Student t-test, and Friedman, Kruskal-Wallis, and chi-square tests were used. RESULTS Of these 52 patients, the mean age at epilepsy onset was 26.3 years, and the mean preoperative seizure frequency was 14 seizures per month. Etiologies included low-grade tumors in 28 (53.8%) patients, cortical dysplasia in 17 (32.7%) patients, and cavernomas in 7 (13.5%) patients. At a mean follow-up of 5.7 years (range 1-10 years), 32 patients (61%) were classified as Engel Class I, 16 patients (31%) were classified as Engel Class II, and 4 (8%) patients were classified as Engel Class III. Overall seizure reduction was significant (p = 0.001). The absence of early postsurgical seizures and lesional etiology were associated with the outcome of Engel Class I (p = 0.05). Twenty-six (50%) patients had complications in the immediate postoperative period, all of which resolved completely with no residual neurological deficits. CONCLUSIONS Surgery for SMA epilepsy guided by ECoG using a multidisciplinary and multimodality approach is a safe, feasible procedure that shows good seizure control, moderate morbidity, and no mortality.
Departments of 1 Neurosurgery and.|Clinical Neurophysiology, Centro Neurológico ABC, Centro Médico ABC Santa Fe, Mexico City.
Mario A
MA
Alonso-Vanegas
Clinical Neurophysiology, National Institute of Neurology and Neurosurgery, Mexico City.|Clinical Neurophysiology, Centro Neurológico ABC, Centro Médico ABC Santa Fe, Mexico City.
Daniel
D
San-Juan
Departments of 1 Neurosurgery and.
Ricardo M
RM
Buentello García
Departments of 1 Neurosurgery and.
Carlos
C
Castillo-Montoya
Department of Neurology, National Institute of Medical Science and Nutrition, Mexico City, Mexico ; and.
Horacio
H
Sentíes-Madrid
Departments of 1 Neurosurgery and.
Erika Brust
EB
Mascher
Clinical Neurophysiology, Centro Neurológico ABC, Centro Médico ABC Santa Fe, Mexico City.
Paul Shkurovick
PS
Bialik
Institute of Clinical Neuroscience and Medical Psychology, University Hospital Düsseldorf, Germany.
Carlos
C
Trenado
D000328:Adult; D000069280:Electrocorticography; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000601:surgery*; D059906:Neuroimaging; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
ECoG = electrocorticography; EEG = electroencephalography; SMA = supplementary motor area; epilepsy surgery; long-term; mesial frontal epilepsy; outcome; supplementary motor area