Five-Year Outcome After Epilepsy Surgery in Nonmonitored and Monitored Surgical Candidates |
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Authors: | Mark D. Holmes&dagger ,Carl B. Dodrill&dagger &Dagger ,Linda M. Ojemann,&dagger &Dagger ,George A. Ojemann&dagger &Dagger |
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Affiliation: | Department of Medicine (Neurology), University of Washington, School of Medicine, Seattle, Washington, U.S.A.;Department of Regional Epilepsy Center, University of Washington, School of Medicine, Seattle, Washington, U.S.A.;Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, Washington, U.S.A. |
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Abstract: | Summary: Purpose : We wished to compare outcome 5 years after temporal lobectomy in 28 patients selected for surgery on the basis of interictal EEG patterns with that in 46 patients who underwent EEG-video monitoring studies as part of their preoperative evaluation during the same era. Methods : The 28 nonmonitored patients had interictal EEG patterns that demonstrated a consistent, unilateral, anterior-midtemporal epileptiform focus, without discordant findings from other studies. Outcomes were assessed for years 4 and 5 after operation. Results : Twenty-six of 28 (92.9%) nonmonitored patients were seizure-free or had at least 75% reduction in seizures. Twenty-nine of 46 (63.0%) monitored patients were seizure-free or had at least 75% reduction in seizures. Preoperative interictal EEGs of 29 of these patients showed independently localized bitemporal, ex-tratemporal, midposterior temporal, or diffuse epileptiform patterns. The remaining 17 monitored patients had preoperative strictly unilateral anterior-midtemporal interictal discharges, and their outcome was comparable to the nonmonitored group, with 15 (88.8%) seizure-free or with at least 75% reduction in seizures. Conclusions : A proportion of candidates for epilepsy surgery can be selected without ictal recordings provided that interictal EEGs demonstrate consistent unilateral anterior-midtemporal epileptiform discharges and that other data are not discordant. |
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Keywords: | Epilepsy surgery Surgical outcome Temporal lobectomy Interictal epileptiform discharges Electroencephalographic-video monitoring |
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