Abstracts

RATIONALE: Anterior temporal lobectomy (ATL) is an accepted form of treatment for patients with intractable temporal lobe epilepsy (TLE). Magnetic resonance imaging (MRI) evidence of mesial temporal sclerosis (MTS) has been shown to predict seizure-free outcome postoperatively. We wanted to evaluate patients with TLE and MTS who underwent ATL but did not become seizure-free. After this program, participants should be able to appreciate characteristics of patients with TLE and MTS who do not become seizure-free after ATL.
METHODS: All patients undergoing ATL for intractable TLE at the Duke Epilepsy Center between 1985 and 2001 were reviewed. Patients that had MTS on presurgical MRI and continued to have seizures postoperatively were enrolled. Clinical characteristics of these patients were noted.
RESULTS: A total of 13 patients were identified that met inclusion criteria. All had histologically proven hippocampal sclerosis. The mean age of onset of epilepsy was 13.5 years; the mean age at the time of surgery was 35.9 years. The mean duration of follow-up was 4.6 years. Eight of 13 (62%) patients had [lt]10 seizures per year after ATL. Five of 13 (38%) patients had [gt]10 seizures per year after TLE surgery. All patients had complex partial seizures postoperatively; three patients also had generalized tonic-clonic seizures. Eight (62%) patients had a history of febrile seizures. Ten (77%) patients had a left ATL, whereas only 3 (23%) had a right ATL.
CONCLUSIONS: Not all patients with MRI evidence of MTS become seizure-free after ATL. There do not appear to be remarkable differences in these patients in comparison to those who are seizure-free after ATL (as reported in literature), other than a higher proportion of patients undergoing left ATL in this group.