Osamah Abdulwahab Mohammed Al-Sahli;Lyudmila Mikhailovna TibekinaSaint Petersburg State University, Russia
Title: Long-term results of surgical treatment of drug-resistant temporal epilepsy
Introduction: Epilepsy is an actual medical and social problem all over the world. About 70 million people suffer from it. At the same time, in 30%- 40% of cases, epilepsy becomes drug-resistant. Surgical treatment is indicated for 20% of patients. This category of patients has significant limitations in daily activities, work, education, socialization due to constant seizures and side effects from anticonvulsant therapy. The main reason for the development of drug-resistant epilepsy (DRE) is hippocampal sclerosis, which in most cases necessitates surgical treatment. However, the volume of surgical intervention and its effectiveness in the long-term period have not been studied enough.
The purpose of the study: To evaluate the results of surgical treatment of patients with DRE in the long-term period with different methods of surgical intervention.
Material and methods: Investigations were carried out in 55 patients with DRE on the basis N. P.Bechtereva Institute of Human Brain, Russian Academy of Sciences. The median age was 35 (Q1- 26.6, Q3-39.5) years; there were 29 men (52.7%), women - 26 (47.3%). The average onset of the disease in patients was 18.6 years; the average duration of the disease before surgery was 15.8 years.
According to MRI of the brain, 32 (58.2%) patients had hippocampal sclerosis (HS), 6 (10.9%) patients had focal cortical dysplasia (FCD), 3 (5.5%) patients had a combination of HS with FCD, 12 (21.8%) patients had a tumor, 1 (1.8%) patient with meningoencephalocele. 37 (67.3%) patients underwent anterior temporal lobectomy (ATL), 3 (5.5%) patients underwent selective amygdalohippocampectomy (SAH), 15 (27.3%) patients underwent selective resection of the epileptogenic focus, and then repeated extended surgery – 15 (27.3%) patients. All patients underwent a comprehensive examination (clinical- neurological, neurophysiological, neuroradiological according to the program "epilepsy").
Results and discussion: The outcomes of surgical treatment were evaluated in 55 patients 6 months after surgery, of which 50 patients - after 1 year, in 7 patients - after 2 years. The proportion of patients with significant improvement according to Engel I/II was 78.1%, 46.0% and 42.9%, respectively, according to the follow-up period. All patients with ATL showed a more favorable outcome in terms of seizure control. 15 (27.3%) patients with selective resection of the epileptogenic focus, there was a slight effect. Thus, they were re-operated with ATL, after which there was a significant decrease in the frequency of seizures.
Conclusions: Preliminary data show a greater effectiveness of seizure control in the late postoperative period in patients with DRE with ATL, which is due to the high probability of eliminating epileptogenic foci and stopping the mechanisms of epileptic discharge irritation. The search for the causes of negative outcomes of surgical treatment and their correction will probably be accompanied by complete control over seizures or a decrease in their frequency, as well as a number of negative manifestations associated with epilepsy.
Osamah Abdulwahab Mohammed Al-Sahli is a postgraduate student at Saint Petersburg State University's Faculty of Medicine's Department of Neurology. Russian Federation Neurologist at the Elizabethan Hospital in Saint Petersburg. Since completing his residency programme, he has published several articles.