Abstracts

The prognosis of surgery for medial temporal lobe epilepsy (MTLE) has been well reported. However, the clinical characteristics of recurred seizure had not been studied. We examined semiology, time, cause and fate of recurred seizure after anterior temporal lobectomy for medial temporal lobe epilepsy (MTLE). We reviewed the medical records of 79 patients who had recurred seizure, out of 227 patients who received anterior temporal lobectomy for MTLE between October 1994 and October 2000. MTLE was defined when hippocampal sclerosis is detected on MRI in the absence of other structural lesion. The types of recurred seizures were similar to the previous seizures in most patients except two. Seizure recurrence happened within the postoperative one month in 33.8%, between one month and one year in 38.2%, during second year in 14.7%, after more than two years in 13.2%. Seizure recurred during the withdrawal phase of antiepileptic medication in 75 % of the patients who had recurrence after one month. In one patient, seizure was provoked by alcohol intake, after two year seizure-free period. Last one-year outcome after recurrence was as follows: seizure free without medication-9.52%; free of disabling seizure-52.4%; rare disabling seizure-21.4%; worthwhile improvement-2.38%; no worthwhile improvement-14.3%. Two patients received re-operation. Most seizure recurrence happened during immediate postoperative period or the withdrawal phase of medication. In considerable patients, seizure recurred after 2 year seizure free period. Final outcome after recurrence was generally favorable.