Surgical Treatment of Complex Partial Seizures: Results, Lessons, and Problems

Abstract

The underlying seizure tendency of complex partial seizures often involves the temporal region of the brain, but the frontal lobe can also produce similar complex partial seizures. By the end of 1980, 1,210 patients with medically refractory temporal lobe epilepsy had been operated on at the Montreal Neurological Institute. Nontumoral epileptogenic lesions were present in 1,034 patients, 169 had tumors, and 7 had major vascular malformations. Thirty-seven percent of the 894 evaluable patients with nontumoral epileptogenic lesions have become and remained seizure-free. Two hundred thirty-six (26%) patients had a marked reduction of seizure tendency. Within the seizure-free group, 63% had a complete or nearly complete reduction of their medically refractory tendency following temporal lobectomy. Of the patients with temporal lobe epilepsy due to tumoral lesions, 46% of the evaluable patients have become and remained seizure-free, and 76% have had a complete or nearly complete reduction of seizure tendency.

Localization of Epileptic Auras Induced on Stimulation by Subdural Electrodes

“…"Running down of fits," according to Salanova et al (11) occurred in most patients with frontal lobe epilepsy and has been described for essentially all anatomic and etiologic subgroups of patients, who were operated on the Montreal Neurological Institute during a period of >50 years. "Running down" of seizures was observed on an average of 18 months after surgery and occurred in 38.5% of the patients with nontumoral temporal lobe epilepsies (12,13). Changes at a cellular level in "running down of fits or auras" have not yet been explained.…”

Ictal scalp EEG recording during sleep and wakefulness: Diagnostic implications for seizure localization and lateralization

“…The following EEG features were assessed: (1) presence of artifacts, defined as greater than 25% of the seizure; (2) focal versus nonfocal IEEG onset, defined as involving two or fewer or more than two electrodes, respectively; and (3) correct localization, defined as ictal discharge located at the epileptogenic zone (the temporal lobe that has been surgically resected with subsequent excellent seizure control) (Rasmussen, 1983).…”

Expanding the role of surgery in intractable extratemporal pediatric epilepsy

“…6 The "running down" or disappearance of habitual seizures within 2-10 years after surgery has been seen in 14% of patients in some case series. 22,23 This phenomenon is felt to be a natural progression of epilepsy after…”