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August 14, 1996

Temporal Lobectomy for Refractory Epilepsy

Author Affiliations

From the Comprehensive Epilepsy Center (Drs Sperling and O'Connor and Ms Plummer), the Department of Neurology (Dr Sperling), and the Division of Neurosurgery (Dr O'Connor), Graduate Hospital, University of Pennsylvania, Philadelphia; and the Department of Psychiatry, Dartmouth University, Hanover, NH (Dr Saykin).

JAMA. 1996;276(6):470-475. doi:10.1001/jama.1996.03540060046034

Objective.  —To examine the long-term effectiveness of anterior temporal lobectomy for refractory epilepsy with regard to seizure control and related medical and psychosocial measures and to determine how patterns of early seizure recurrence relate to long-term prognosis.

Design.  —A cohort of patients prospectively followed up for 5 years after surgery.

Setting.  —Tertiary care comprehensive epilepsy center.

Patients.  —Eighty-nine patients with medically refractory epilepsy who were consecutively treated with anterior temporal lobectomy between 1986 and 1990. All patients had noninvasive preoperative evaluations, and 31 were evaluated with intracranial electrodes prior to surgery.

Main Outcome Measures.  —Postoperative seizure frequency, neuropsychologic function, mortality, and postoperative employment status.

Results.  —Five years after surgery, 62 patients (70%) were seizure free, 8 (9%) had seizures on fewer than 3 days per year or exclusively had nocturnal seizures, 10(11 %) had greater than 80% reduction in seizure frequency, 5 (6%) had less than 80% reduction in seizure frequency, and 4 (4%) died of causes unrelated to surgery. The proportion of patients in each outcome class remained stable throughout the 5-year period. Fifty-five percent of seizure recurrences happened within 6 months of surgery, and 93% occurred within 2 years after surgery. Outcome at 1 year related only moderately well to outcome at 5 years. No significant cognitive or linguistic deficits occurred. All patients who died had persistent seizures after surgery. Underemployment and unemployment declined significantly after surgery, with improvement noted in seizure-free patients.

Conclusions.  —Temporal lobectomy provides sustained seizure relief over 5 years to most patients who have surgery. Outcome at 2 years predicts long-term outcome. A seizure-free state is associated with reduced mortality and increased employment. Mere reduction in seizure frequency is not associated with improvement in those measures.