Practice Parameter: Temporal Lobe and Localized Neocortical Resections for Epilepsy

Report of the Quality Standards Subcommittee of the American Academy of Neurology, in Association with the American Epilepsy Society and the American Association of Neurological Surgeons

Authors

  • Jerome Engel Jr.,

  • Samuel Wiebe,

  • Jacqueline French,

  • Michael Sperling,

  • Peter Williamson,

  • Dennis Spencer,

  • Robert Gumnit,

  • Catherine Zahn,

  • Edward Westbrook,

  • Bruce Enos


  • Approved by the Quality Standards Subcommittee on April 16, 2002. Approved by the Practice Committee on August 3, 2002. Approved by the AAN Board of Directors on October 19, 2002. Published in Neurology 2003;60:538–547.

  • Additional material related to this article can be found on the Neurology website. Go to www.neurology.org and scroll down the table of contents for the February 25 issue to find the link for this article.

Address correspondence and reprint requests to Jerome Engel, Jr. at Reed Neurological Research Center, Department of Neurology #1250, 710 Westwood Plaza, Los Angeles, CA 90095-1769, U.S.A. E-mail: engel@ucla.edu

Abstract

Summary: Purpose: To examine evidence for effectiveness of anteromesial temporal lobe and localized neocortical resections for disabling complex partial seizures.

Methods: Systemic review and analysis of the literature since 1990.

Results: One intention-to-treat Class I randomized controlled trial of surgery for mesial temporal lobe epilepsy found that 58% of patients randomized to be evaluated for surgical therapy (64% of those who received surgery) were free of disabling seizures and 10 to 15% were unimproved at the end of 1 year, compared with 8% free of disabling seizures in the group randomized to continued medical therapy. There was a significant improvement in quantitative quality-of-life scores and a trend toward better social function at the end of 1 year for patients in the surgical group, no surgical mortality, and infrequent morbidity. Twenty-four Class IV series of temporal lobe resections yielded essentially identical results. There are similar Class IV results for localized neocortical resections; no Class I or II studies are available.

Conclusions: A single Class I study and 24 Class IV studies indicate that the benefits of anteromesial temporal lobe resection for disabling complex partial seizures is greater than continued treatment with antiepileptic drugs, and the risks are at least comparable. For patients who are compromised by such seizures, referral to an epilepsy surgery center should be strongly considered. Further studies are needed to determine if neocortical seizures benefit from surgery, and whether early surgical intervention should be the treatment of choice for certain surgically remediable epileptic syndromes.

Ancillary