Surgical Treatment of Extratemporal Epilepsy: Clinical, Radiologic, and Histopathologic Findings in 60 Patients
Article first published online: 3 AUG 2005
Volume 37, Issue 11, pages 1072–1080, November 1996
How to Cite
Zentner, J., Hufnagel, A., Ostertun, B., Wolf, H. K., Behrens, E., Campos, M. G., Solymosi, L., Elger, C. E., Wiestler, O. D. and Schramm, J. (1996), Surgical Treatment of Extratemporal Epilepsy: Clinical, Radiologic, and Histopathologic Findings in 60 Patients. Epilepsia, 37: 1072–1080. doi: 10.1111/j.1528-1157.1996.tb01027.x
- Issue published online: 3 AUG 2005
- Article first published online: 3 AUG 2005
- Accepted July 15, 1996.
- Extratemporal epilepsy;
- Epilepsy surgery;
- Magnetic resonance imaging;
- Seizure outcome
Summary: Purpose and Methods: The aim of this study was to analyze clinical, radiologic, and histopathologic findings in 60 consecutive patients with medically intractable extratemporal epilepsy who were operated on between November 1987 and May 1993.
Results: Histologically, there were distinct structural abnormalities in 50 (83%) of the surgical specimens. Signal abnormalities on magnetic resonance imaging (MRI) were present in all patients with neoplastic lesions (n = 17) and in 94% of patients with nonneoplastic focal lesions (n = 32). Overall, structural abnormalities were detected by MRI in 47 (96%) of 49 patients with focal lesions. During a mean follow-up of 4 years, 30 (54%) patients remained completely seizure free, 11 (20%) had ≤2 seizures per year, seven (12%) showed a seizure reduction of ≥75%, and eight (14%) had <75% reduction in seizure frequency. The fraction of seizure-free patients was 12 (80%) of 15 in patients with neoplastic lesions, 16 (52%) of 31 in patients with nonneoplastic focal lesions, and two (20%) of 10 for those without histopathologic abnormalities. The differences in seizure outcome between patients with and without focal lesions were statistically significant (p < 0.05), if seizure-free outcome was compared with persistent seizures.
Conclusions: Focal lesions and particularly neoplasms are associated with improved postoperative seizure control compared with patients without histopathologic abnormalities. We advise caution in considering surgery to treat extratemporal epilepsy in patients who have normal MRI scans, because the outcome with the approach described in this study is poor in such cases.