What is the role of lobectomy in the treatment of epilepsy?

Updated: May 30, 2019
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Outcomes of temporal-lobe surgeries are better than those for surgeries in other areas. If a patient has unilateral temporal-lobe seizures (as observed on video-EEG) and unilateral hippocampal sclerosis (as observed on brain magnetic resonance imaging [MRI]), the likelihood of a class I outcome (no seizures or only auras) at 2 years is about 85%.

In a randomized, controlled trial of surgery in 80 patients with temporal lobe epilepsy, 58% of patients in the group randomized to anterior temporal lobe resective surgery were free from seizures impairing awareness at 1 year, as compared with 8% in the group that received anticonvulsant treatment. [71] Quality of life was also superior for patients in the surgical group.

According to research, MRI-guided selective laser amygdalohippocampectomy (SLAH) is at least as effective as standard resection. In a study of 7 patients who received SLAH and 10 patients who underwent standard resection (either open anterior temporal lobectomy or selective amygdalohippocampectomy), 9 of 10 patients in the latter group showed a significant decline on visual/verbal memory tasks (P< .002), compared with 1 of 7 patients in the former group. [41] Whereas 6 of 7 laser-ablation patients showed significant improvement on 1 or more memory measures, only 4 of 10 standard-resection patients did (P< .02). [41]


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