Surgical Treatment for mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis. Our Experience.

Abstract

Introduction; Epilepsy is one of the most common neurological chronic disorders, with an estimated prevalence of 0. 5 – 1%. Partial focal epilepsy (PE) is one of the most common types of epilepsies that originates from a relatively limited number of neurons, whose malfunction generates epileptic attacks. Partial focal epilepsies make up 60% of the whole spectrum of epilepsies. Recent studies show that 25% of patient who suffer from PE show a resistance against medication. The duration of symptoms on the one hand and AED treatment on the other hand cause the cognitive dysfunctions in the patients suffering from epileptic seizures, especially children, to suffer progressive damage. Patients suffering from epilepsy have a cost that at the moment is difficult to calculate accurately, but it is still very high. Mesial Temporal lobe seizures are the most common form of partial epileptic seizures originating in the temporal lobe, and they are frequently resistant to anti-epileptic drug treatment.

Materials and Methods, At Neurosurgical Department, University Hospital “Mother Theresa”, since 2013 there is a team consisting of different medical specialists, for the study and selection of candidates, who can benefit from surgery. At the same time, since many years now in neurological department there is already a successful tradition in the medicament treatment of epilepsy.

The team of medical doctors in our Department, which makes the treatment of these diseases by means of surgery, is made up of: neuro-epileptologist, radiologists, neurologists, psychologists and neurosurgeons.

During the period, from 2013 until the year 2021, 35 patients have undergone an operation. All the patients were considered, based on   protocols, as pharmacoresistant.

Conclusions; The post-surgical results were 80% of the patient’s seizure free and without need to use any antiepileptic treatment, meaning Engel 1. 15% of the patients were seizure free but with the need of antiepileptic treatment and meaning Engel 2 and 5% of patients were not able to be cured by achieving only a modification of the semiology of the crisis and frequency, meaning Engel 3.

Anterior temporal lobectomy in majority of the cases is the best surgical treatment of drug-resistant HS-TLE and long-term seizure free patients in this group have been reported about 70% (62-83%).