Post-temporal lobectomy seizures.

Abstract

A retrospective analysis of 62 patients followed up after temporal lobectomy was carried out, with particular regard to examining the features of post-operative seizures. All patients had been routinely assessed for operative suitability in the Comprehensive Epilepsy Programme at the Austin Hospital and had been followed at intervals with post-operative EEG, CT, clinical and neuropsychological examination. It was found that 37 patients experienced no further seizures; 3 patients showed 'neighbourhood seizures' in the immediate post-operative fort-night; 10 patients exhibited the 'running down phenomenon' of Rasmussen, in which seizures had vanished by 6 months' follow-up; 6 patients showed complex partial seizures persisting at a greatly reduced rate (under 75%); 6 patients, for a number of reasons, showed no benefit from surgery. Half of all patients showed persisting auras to varying degrees, with gradual lessening in frequency and virtual disappearance. Criteria for post-operative CT and EEG abnormality were developed. It was found that these factors were seen in approximately 20% of the successful group, but in all patients showing persisting or 'running down' or 'neighbourhood' seizures. All 3 patients not benefiting from surgery, whose failure defied any other explanation, also showed very significant CT and EEG abnormalities; it is not clear which factor caused the fits to persist. It would seem that operative trauma and its sequelae play a considerable role in post-lobectomy seizures.