Neurology 2003;60:538-547
© 2003 American Academy of Neurology
Special Article
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
J. Engel, Jr., MD PhD,
S. Wiebe, MD,
J. French, MD,
M. Sperling, MD,
P. Williamson, MD,
D. Spencer, MD,
R. Gumnit, MD,
C. Zahn, MD,
E. Westbrook, MD and
B. Enos, MD PhD
Address correspondence and reprint requests to Dr. Jerome Engel, Jr., Reed Neurological Research Center, Department of Neurology #1250, 710 Westwood Plaza, Los Angeles, CA 90095-1769; e-mail: engel{at}ucla.edu
Objectives/Methods: To examine evidence for effectiveness of anteromesial temporal lobe and localized neocortical resections for disabling complex partial seizures by systematic 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.
This article has been cited by other articles:
|
|
|
|
 
C. G. Bien, M. Szinay, J. Wagner, H. Clusmann, A. J. Becker, and H. Urbach
Characteristics and Surgical Outcomes of Patients With Refractory Magnetic Resonance Imaging-Negative Epilepsies
Arch Neurol,
December 1, 2009;
66(12):
1491 - 1499.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. C. Van Ness
Surgery Is the Best Option for Intractable Unilateral Mesial Temporal Epilepsy
Arch Neurol,
December 1, 2009;
66(12):
1554 - 1556.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K.K. Lee and N. Salamon
[18F] Fluorodeoxyglucose-Positron-Emission Tomography and MR Imaging Coregistration for Presurgical Evaluation of Medically Refractory Epilepsy
AJNR Am. J. Neuroradiol.,
November 1, 2009;
30(10):
1811 - 1816.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. C. Bernhardt, K. J. Worsley, H. Kim, A. C. Evans, A. Bernasconi, and N. Bernasconi
Longitudinal and cross-sectional analysis of atrophy in pharmacoresistant temporal lobe epilepsy
Neurology,
May 19, 2009;
72(20):
1747 - 1754.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Kanner, R. Byrne, A. Chicharro, J. Wuu, and M. Frey
A lifetime psychiatric history predicts a worse seizure outcome following temporal lobectomy
Neurology,
March 3, 2009;
72(9):
793 - 799.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Choi, R. L. Sell, L. Lenert, P. Muennig, R. R. Goodman, F. G. Gilliam, and J. B. Wong
Epilepsy Surgery for Pharmacoresistant Temporal Lobe Epilepsy: A Decision Analysis
JAMA,
December 3, 2008;
300(21):
2497 - 2505.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Engel Jr
Surgical Treatment for Epilepsy: Too Little, Too Late?
JAMA,
December 3, 2008;
300(21):
2548 - 2550.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. D. Bell and A. R. Giovagnoli
Memory after temporal lobe epilepsy surgery: Risk and reward
Neurology,
October 21, 2008;
71(17):
1302 - 1303.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Krendl, S. Lurger, and C. Baumgartner
Absolute spike frequency predicts surgical outcome in TLE with unilateral hippocampal atrophy
Neurology,
August 5, 2008;
71(6):
413 - 418.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. L. Holmes
Animal model studies application to human patients
Neurology,
December 11, 2007;
69(24_suppl_3):
S28 - S32.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M.J.V. Pugh, D. R. Berlowitz, G. Montouris, B. Bokhour, J. A. Cramer, V. Bohm, M. Bollinger, S. Helmers, A. Ettinger, K. J. Meador, et al.
What constitutes high quality of care for adults with epilepsy?
Neurology,
November 20, 2007;
69(21):
2020 - 2027.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. F. Tellez-Zenteno, R. Dhar, L. Hernandez-Ronquillo, and S. Wiebe
Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects
Brain,
February 1, 2007;
130(2):
334 - 345.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Matsumoto, D. R. Nair, E. LaPresto, W. Bingaman, H. Shibasaki, and H. O. Luders
Functional connectivity in human cortical motor system: a cortico-cortical evoked potential study
Brain,
January 1, 2007;
130(1):
181 - 197.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. F. Tellez-Zenteno, R. Dhar, and S. Wiebe
Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis
Brain,
May 1, 2005;
128(5):
1188 - 1198.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Trevathan and F. Gilliam
Lost years: Delayed referral for surgically treatable epilepsy
Neurology,
August 26, 2003;
61(4):
432 - 433.
[Full Text]
[PDF]
|
|
|
|
