Abstracts

Rationale: Epileptologists select candidates for resection based on clinical semiology and concordance of a data set that may involve multiple analyses including anatomical and functional/metabolic neuroimaging, interictal and ictal video-EEG data, neuropsychiatric testing, and ultimately on the identification of a fairly focal epileptogenic or ictal onset zone. Patients who present as intractable and disabled from seizure activity in fact may have a dataset with more diffuse or poorly localized predominantly frontal localization and often there is lack of consensus to proceed with any attempts of a focal resection under these circumstances, particularly in these cases because frontal lobe onset seizures historically have the lowest surgical cure rates despite surgical risks. This poster/article reviews several patients which were deemed intractable and disabled but were judged initially not to be good surgical candidates in the early years of their clinical presentations due to the lack of concordant data sets, but once they had exhausted multiple conventional options, were taken for invasive predominantly frontal lobe video EEG monitoring and ultimately had palliative resective topectomies in regions either of predominant ictal onset or in regions with highest ictal or interictal epileptiform discharges. Remaining regions of cortical irritability that were also present in such patients were unresected outside of the area of topectomy, but the cortical topectomies performed as noted after a follow up period retrospectively seem to have associated clinical improvements despite the presence of remaining zones of cortical irritability in such patients. Methods: At Lahey Hospital and Medical Center cases of intractable and disabling frontal onset seizures that ultimately had palliative topectomies/resections in regions identifying the predominant ictal onset zones or in regions with the highest ictal or interictal epileptiform discharges were identified and clinical elements were retrospectively reviewed. Results: Despite lack of complete concordance of data set in perioperative assessment, frontal topectomy may be palliative in difficult to localize intractable and disabling frontal epilepsy cases when such cases are retrospectively reviewed after a follow up period post resection. Conclusions: Focal topectomy in selected patients with disabling and intractable seizures with difficult to localize frontal lobe onset seizures may be palliative and should be a subject of further study.