On the best strategies on the best results for surgery of frontal epilepsy

Frontal lobe epilepsy surgery is the second most common surgery performed for drug-resistant partial epilepsy. We investigated the longitudinal outcome in a cohort of patients investigated since 1990 with SEEG and modern diagnostic techniques. We reviewed 105 patients who underwent surgery between 1...

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Bibliographic Details
Published in:Neuro-chirurgie 2008-05, Vol.54 (3), p.388-398
Main Authors: Trottier, S, Landré, E, Biraben, A, Chassoux, F, Pasnicu, A, Scarabin, J-M, Turak, B, Devaux, B
Format: Article
Language:fre
Subjects:
Adolescent
Adult
Child
Child, Preschool
Cohort Studies
Dominance, Cerebral - physiology
Electroencephalography
Electrophysiology
Epilepsy, Frontal Lobe - etiology
Epilepsy, Frontal Lobe - pathology
Epilepsy, Frontal Lobe - surgery
Female
Follow-Up Studies
Functional Laterality
Humans
Infant
Longitudinal Studies
Male
Middle Aged
Motor Cortex - pathology
Neurosurgical Procedures - methods
Patient Selection
Postoperative Complications - epidemiology
Postoperative Complications - psychology
Seizures - epidemiology
Seizures - physiopathology
Treatment Outcome
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Summary:Frontal lobe epilepsy surgery is the second most common surgery performed for drug-resistant partial epilepsy. We investigated the longitudinal outcome in a cohort of patients investigated since 1990 with SEEG and modern diagnostic techniques. We reviewed 105 patients who underwent surgery between 1990 and 2005 (mean follow-up, six years; range: one to 17 years) and analyzed the year-per-year follow-up according to Engel's classification. Favorable outcome (Class I) was observed for 70% and this result was stable at least five years after surgery. More than 90% of patients with lesion-related epilepsies (focal cortical dysplasia and dysembryoplastic neuroepithelial tumors) became seizure-free. Less than 50% of patients classified as having cryptogenic epilepsy (defined as normal imaging and neuropathology on surgical specimen) had a favorable outcome. Permanent neurological sequelae were subtle and rare, especially after surgery for dysplasia in eloquent cortex (primary motor cortex). Our data indicate that frontal surgery is a successful treatment in patients when electrophysiological and morphological investigations demonstrate a well-defined epileptogenic zone or lesion to be surgically resected. Progress in electrophysiological and brain-imaging techniques will further improve the selection of frontal lobe epilepsy surgery candidates.
ISSN:0028-3770
DOI:10.1016/j.neuchi.2008.02.040