Abstracts

RATIONALE: TLE is the epileptic syndrome most ammenable to surgery. Patients being considered for surgery who have TLE, unilateral MTS and unilateral interictal temporal lobe spiking do not need prolonged video-EEG monitoring during their work-up and a rate around 90% of seizure-free patients might be expected after cortico-amygdalo-hipocampectomy (CAH). Many series suggested that patients with BITLS might have a worse surgical prognosis. This study reports our surgical results in patients with refractory TLE, BITLS and MRI-defined unilateral MTS. METHODS: Thirty-five patients with BITLS, unilateral MTS and who were submitted to CAH at the MTS's side were studied. No patient had video-EEG monitoring. Mean age at surgery was 26 years (18-48) and mean seizure frequency 1x/week. All patients had complex partial seizures and 78% of them had simple partial seizures. The mean follow-up time was 18 months (4-48). Preoperatively, six patients had interictal discharges prevailing over the non-operated temporal-lobe. RESULTS: Thirty patients have been seizure-free since surgery (85%) and 5 are in Engel's class II. There was no surgical morbidity or mortality. There were no additional memory deficits postoperatively. Five out of the 6 patients with interictal discharges prevailing at the non-operated side have been seizure-free since surgery. CONCLUSIONS: The surgical results obtained in this series (85% of seizure-free patients) are slightly worse than those obtained in a series of patients with unilateral temporal lobe spiking (91% of patients under remission) but no statistical differance was reached. Patient with BITLS can also obtain good surgical results after unilateral CAH. Patients with interictal spiking prevailing at the side contralateral to the MTS may also have a good outcome and might not be disconsidered for surgery.