Presurgical electroencephalographic patterns and outcome from anterior temporal lobectomy
E. Barry, N. M. Sussman, M. J. O'Connor and R. N. Harner
Department of Neurology, University of Maryland, Baltimore.
We reviewed data from 48 patients after anterior temporal lobe resection
for medically intractable epilepsy. All had ictal electro-encephalographic
(EEG) evidence of unilateral temporal lobe onset. Depth electrodes were
used in 19 patients. Successful surgical outcome correlated significantly
with factors that suggested a temporal lobe focus, particularly in the
interictal scalp EEG. The most successful outcome occurred in patients with
well-localized unilateral interictal temporal spikes (100% improved). The
group with well-localized bilateral temporal spikes also did well (76%
improved). Patients with extratemporal spread of the interictal spike on
scalp EEG, either unilaterally or bilaterally, did less well. Only one
third improved, despite extensive extracranial and intracranial monitoring,
when indicated. The interictal scalp EEG may be the only EEG necessary for
the presurgical evaluation of selected patients with intractable temporal
lobe epilepsy.
