Surgical management of independent bihemispheric seizure foci

Arun Angelo Patil, Richard Andrews

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

A combination of nonresective and minimally resective (NRMR) procedures were used to treat a series of patients with intractable seizures who were poor candidates for conventional epilepsy surgery because of their independent bihemispheric seizure foci. Over the past 5 years, 10 patients with bihemispheric seizure foci have had seizure surgeries on both hemispheres and have had postoperative follow-up for a minimum of 6 months. Preoperative investigations included magnetic resonance (MR) imaging, positron emission tomography (PET) scanning, and video-EEG monitoring with surface and subdural electrodes. Multiple subpial cortical transection (MST) was the primary procedure in all 10 patients. Following MST, 8 patients had minimal cortical resection (topectomy) in areas that continued to show epileptiform discharges in prolonged trains on intraoperative corticography. In addition, stereotactic amygdalohippocampotomy was performed on 2 patients. The longest follow-up is 62 months, with a median of 16 months. Five patients are free of seizures; 3 have rare seizures; 1 has >90% reduction in seizure frequency; and 1 has complete cessation of myoclonic seizures with >50% reduction in frequency of complex partial seizures. There were no complications from any of the procedures. The results indicate that seizures originating from both hemispheres can be effectively and safely controlled by a combination of surgical procedures.

Original languageEnglish (US)
Pages (from-to)203-207
Number of pages5
JournalJournal of Epilepsy
Volume10
Issue number4
DOIs
StatePublished - Jan 1 1997

Keywords

  • Bihemispheric seizure foci
  • Epilepsy surgery
  • Intractable seizures
  • Subpial transections

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology

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