Abstracts

Rationale: Seizures of the orbital frontal cortex are associated with suggestive but non-specific behavioral expression, and investigation using MRI, ictal SPECT, and intracranial electrode video-EEG monitoring may enable surgical resection with satisfactory seizure outcome. We present a 15 year experience at a comprehensive surgical epilepsy program. Methods: Between 1993 and 2008, 17 patients underwent resection of the orbital frontal cortex for treatment of medically refractory epilepsy (9 female, mean age 32.5 years with range of 17 to 53 years). Preoperative evaluation included an intracranial study in 15 patients. Results: Seizure expression was most commonly characterized by hypermotor automatisms, although these have not been specific to orbital frontal cortex; sexual automatisms were seen in two patients. Surgical treatment was associated with one infection but no permanent morbidity and no mortality. Follow-up of at least one year is available in 14 patients (range 1-12 years, mean 5 1/2 years): Class I (seizure-free) outcome was achieved in 9 patients, Class II in 2 patients, Class III in 2 patients, and Class IV in 1 patient. Conclusions: Intractable epilepsy involving the orbital frontal cortex can be identified and surgically treated with excellent or good outcome in the majority of patients.