SURGERY FOR TEMPORAL-LOBE EPILEPSY

Interest in surgery for intractable temporal lobe epilepsy has increased during the last ten years, mainly die to a better identification of the epileptogenic focus by modern imaging techniques (MRI) or functional tools (TEP and SPECT scanning). Depth electrodes recording is not mandatory and can be restricted to patients who do not meet congruent non invasive criteria. Simultaneously, modification of surgical techniques has been proposed : in addition to classical temporal lobectomy, other methods are used in order to minimize the resection of temporal lateral neocortex, and increase that of mesial temporal structures; the latter can be selectively performed through amygdalo-hyppocampectomy. Outcome of surgery is generally excellent or good. More than three-fourths of patients are seizure free or show major reduction in seizure frequency. Outcome at the end of the second year is a good indication of long-term prognosis.