Surgical treatment for multifocal epilepsy

Abstract

Aim. Assessment of the surgical treatment efficacy in multifocal epilepsy by a differentiated surgical approach depending on the clinical manifestations of the disease and structural and functional changes of the brain. Materials and methods. 48 patients with multifocal epilepsy (MFE) were enrolled in the study including 37 (77 %) children and 11 (23 %) adults. Patient age ranged from 2 to 44 years (mean 12.7 years). Most patients (46 (95.8 %) cases) had daily seizures. Before the treatment, the patients used between 2 and 11 antiepileptic drugs (on average 5.1 ± 2.5) as mono- or polytherapy. 12 (25.0 %) patients underwent stereotactic callosotomy (SC), 18 (37.5 %) – microsurgical callosotomy (MC), 6 (12.5 %) – multifocal resections (MFR), 12 (25.0 %) – functional hemispherotomy (FH). Postoperative long-term follow-up ranged from 6 months to 11 years (mean 5.5 years). Results. Multiple epileptiform focuses or diffuse structural and electric discharges within one hemisphere observed in 25 (52 %) cases; bilateral structural lesions revealed in 19 (40 %) cases; MRI-negative epilepsy with bilateral discharges – in 4 (8 %) patients. After surgery, 23 (48 %) patients became seizures free (Engel Class IA), 8 (17 %) patients had rare short auras or focal seizures (Engel Class II), the seizure frequency reduced by less than 75 % or did not change significantly in 6 (13 %) cases. Best results were achieved after FH and MFR (90 % patients became seizures free), whereas seizures stopped only in 25 % cases after SC. 3 (6.3 %) patients developed operative complications, one of them died (postoperative mortality was 2.1 %). Conclusions. Combination of resective and disconnection surgeries is effective and safe method of surgical treatment for MFE. Stopping seizures leads to the regression of psycho-emotional disorders in children with severe epilepsy and increases the quality of life.

Keywords

• epilepsy
• multilobar resections
• callosotomy
• functional hemispherotomy