Tehran University Medical Journal

Background: Regarding the complications of chronic intractable epilepsy, the presence of respectable lesions in many these patients that can be diagnosed with noninvasive sensitive techniques such as MRI and SPECT and the unrecognized significance of epilepsy surgery in our country, we have decided to review the management of medically intractable epilepsy in patients, who underwent epilepsy surgery in neurosurgery department of Loghman Hakim hospital between 1997-2003.

Materials and Methods: In this study we retrospectively review 30 cases of medically intractable epilepsy that had underwent epilepsy surgery. All patients before surgery were investigated with brain MRI, brain SPECT, EEG and IQ test. Type of surgery was determined by MRI, SPECT and EEG findings. Pre - and postoperative seizure frequency and surgery complications studied. Seizure control was measured with Engel criteria.

Results: Patients mean age was 22.4 years. Three cases (10%) were females that all underwent temporal mesial lobectomy. In 18 cases (60%) there were concordant brain lesion with seizure origin that 9 cases (30%) underwent mesial temporal lobectomy and remainder 9 cases (30%) underwent lesionectomy.other12 cases (40%) that have uncertain brain lesion but suffer from drop attack due to one or combination of atonic, tonic, tonic clonic, clonic, myoclonic, absence or clonic underwent anterior callosotomy. patients that underwent mesial temporal lobectomy, anterior callosotomy and lesionectomy were seizure-free in 77.7%, 58.3% and 55.5% of cases respectively.

Conclusions: Provided to correct patient selection for epilepsy surgery we can manage intractable epilepsy properly. Regarding to the complication of intractable epilepsy, acceptable epilepsy surgery results and available sensitive noninvasive diagnostic techniques such as MRI in our country, epilepsy surgery should be considered seriously in our country and promoted.