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August 14, 1996, Vol 276, No. 6 >
ARTICLE | August 14, 1996

Temporal Lobectomy for Refractory Epilepsy FREE

Michael R. Sperling, MD; Michael J. O'Connor, MD; Andrew J. Saykin, PsyD; Carrie Plummer
[+] Author Affiliations

Presented in part at the annual meeting of the American Academy of Neurology, Seattle, Wash, May 10, 1995.

Corresponding author: Michael R. Sperling, MD, Comprehensive Epilepsy Center, Graduate Hospital, 1800 Lombard St, Philadelphia, PA 19146.


JAMA. 1996;276(6):470-475. doi:10.1001/jama.1996.03540060046034
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References

Objective.  —To examine the long-term effectiveness of anterior temporal lobectomy for refractory epilepsy with regard to seizure control and related medical and psychosocial measures and to determine how patterns of early seizure recurrence relate to long-term prognosis.

Design.  —A cohort of patients prospectively followed up for 5 years after surgery.

Setting.  —Tertiary care comprehensive epilepsy center.

Patients.  —Eighty-nine patients with medically refractory epilepsy who were consecutively treated with anterior temporal lobectomy between 1986 and 1990. All patients had noninvasive preoperative evaluations, and 31 were evaluated with intracranial electrodes prior to surgery.

Main Outcome Measures.  —Postoperative seizure frequency, neuropsychologic function, mortality, and postoperative employment status.

Results.  —Five years after surgery, 62 patients (70%) were seizure free, 8 (9%) had seizures on fewer than 3 days per year or exclusively had nocturnal seizures, 10(11 %) had greater than 80% reduction in seizure frequency, 5 (6%) had less than 80% reduction in seizure frequency, and 4 (4%) died of causes unrelated to surgery. The proportion of patients in each outcome class remained stable throughout the 5-year period. Fifty-five percent of seizure recurrences happened within 6 months of surgery, and 93% occurred within 2 years after surgery. Outcome at 1 year related only moderately well to outcome at 5 years. No significant cognitive or linguistic deficits occurred. All patients who died had persistent seizures after surgery. Underemployment and unemployment declined significantly after surgery, with improvement noted in seizure-free patients.

Conclusions.  —Temporal lobectomy provides sustained seizure relief over 5 years to most patients who have surgery. Outcome at 2 years predicts long-term outcome. A seizure-free state is associated with reduced mortality and increased employment. Mere reduction in seizure frequency is not associated with improvement in those measures.

REFERENCES

1 +
Hauser WA, Hesdorffer DC. Epilepsy: Frequency, Causes, and Consequences . New York, NY: Demos Publications; 1990;.
2 +
Dikmen S, Morgan SF.  Neuropsychological factors related to employability and occupational status in persons with epilepsy . J Nerv Ment Dis . 1980;;168:236-240.
3 +
Rodin E, Rennick P, Dennerll R, Lin Y.  Vocational and educational problems of epileptic patients . Epilepsia . 1972;;13:149-160.
4 +
Elwes RD, Marshall J, Beattie A, Newman PK.  Epilepsy and employment: a community based survey in an area of high unemployment . J Neurol Neurosurg Psychiatry . 1991;;54:200-203.
5 +
Johnston SC, Horn JK, Valente J, Simon RP.  The role of hypoventilation in a sheep model of epileptic sudden death . Ann Neurol . 1995;;37:531-537.
6 +
Smith DF, Baker GA, Dewey M, Jacoby A, Chadwick DW.  Seizure frequency, patient perceived seizure severity, and the psychosocial consequences of intractable epilepsy . Epilepsy Res . 1991;;9:231-241.
7 +
Sperling MR, Saykin AJ, Roberts DF, French JA, O'Connor MJ.  Occupational outcome after temporal lobectomy for refractory epilepsy . Neurology . 1995;;45:970-977.
8 +
Taylor DC.  Psychiatric and social issues in measuring the input and outcome of epilepsy surgery . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . New York, NY: Raven Press Inc; 1987;: 485-503.
9 +
Engel J Jr, Shewmon AD.  Who should be considered a surgical candidate . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . 2nd ed. New York, NY: Raven Press; 1993;:23-34.
10 +
Bengzon ARA, Rasmussen T, Gloor P, Dussault J, Stephens M.  Prognostic factors in the surgical treatment of temporal lobe epileptics . Neurology . 1968;;18:717-731.
11 +
Bonis A.  Long-term results of cortical excisions based on the stereotaxic investigation in severe drug resistant epilepsies . Acta Neurochir . 1980;;30 ( (suppl) ):55-66.
12 +
Cahan L, Sutherling WW, McCullough M, Rausch R, Engel J, Crandall PH.  Review of the 20-year UCLA experience with surgery for epilepsy . Clev Clin Q . 1984;;51:313-318.
13 +
Dodrill CB, Wilkus RF, Ojemann GA, et al.  Multidisciplinary prediction of seizure relief from cortical resection surgery . Ann Neurol . 1986;;20:2-12.
14 +
Elwes RD, Dunn G, Binnie CD, Polkey CE.  Outcome following resective surgery for temporal lobe epilepsy . J Neurol Neurosurg Psychiatry . 1991;; 54:949-952.
15 +
Falconer MA, Serafetinides EA.  A follow-up study of surgery in temporal lobe epilepsy . J Neurol Neurosurg Psychiatry . 1963;;26:154-165.
16 +
Goldring S, Gregorie EM.  Surgical management of epilepsy using epidural recordings to localize the seizure focus . J Neurosurg . 1984;;60:457-466.
17 +
Guldvog B, Loyning Y, Hauglie-Hanssen E, Flood S, Bjornaes H.  Surgical treatment for partial epilepsy among Norwegian adults . Epilepsia . 1994;; 35:540-553.
18 +
Guldvog B, Loyning Y, Hauglie-Hanssen E, Flood S, Bjornaes H.  Surgical treatment for partial epilepsy among Norwegian children and adolescents . Epilepsia . 1994;;35:554-565.
19 +
Jensen I.  Temporal lobe epilepsy: types of seizures, age, and surgical results . Acta Neurol Scand . 1976;;53:335-357.
20 +
King DW, Flanigin HF, Gallagher BB, et al.  Temporal lobectomy for partial complex seizures: evaluation, results, and 1-year followup . Neurology . 1986;;36:334-339.
21 +
Mizrahi EM, Kellaway P, Grossman RG, et al.  Anterior temporal lobectomy and medically refractory temporal lobe epilepsy of childhood . Epilepsia . 1990;;31:302-312.
22 +
Rasmussen TB.  Surgical treatment of complex partial seizures: results, lessons, and problems . Epilepsia . 1983;;24( (suppl 1) ):S65-S76.
23 +
Rougier A, Dartigues J, Commenges, D, Claverie B, Loiseau P, Cohadon F.  A longitudinal assessment of seizure outcome and overall benefit from 100 cortectomies for epilepsy . J Neurol Neurosurg Psychiatry . 1992;;55:762-767.
24 +
Van Buren JM, Ajmone-Marsan C, Mutsuga N, Sadowsky D.  Surgery of temporal lobe epilepsy . Adv Neurol . 1975;;8:155-181.
25 +
Walczak TS, Radtke RA, McNamara JO, et al.  Anterior temporal lobectomy for complex partial seizures . Neurology . 1990;;20:413-418.
26 +
Sperling MR, O'Connor MJ, Saykin AJ, et al.  A non-invasive protocol for anterior temporal lobectomy . Neurology . 1992;;42:416-422.
27 +
Saykin AJ, Robinson LJ, Stafiniak P, et al.  Neuropsychological effects of temporal lobectomy: acute changes in memory, language and music . In: Bennett T, ed. Neuropsychology of Epilepsy . New York, NY: Plenum Publishing Corp; 1992;:263-290.
28 +
Sperling MR, O'Connor MJ.  Comparison of depth and subdural electrodes in recording temporal lobe seizures . Neurology . 1989;;39:1487-1504.
29 +
Engel J Jr.  Outcome with respect to epileptic seizures . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . New York, NY: Raven Press; 1987;: 553-571.
30 +
Sperling MR, Saykin AJ, Glosser G, Moran M, French JA, O'Connor MJ.  Predictors of outcome after anterior temporal lobectomy: the intracarotid amobarbital test . Neurology . 1994;;44:2325-2330.
31 +
Sperling MR, Wilson G, Engel J Jr, Babb TL, Phelps M, Bradley W.  Magnetic resonance imaging in intractable partial epilepsy: correlative studies . Ann Neurol . 1986;;20:57-62.
32 +
Berkovic SF, MacIntosh AM, Kalnins RM, et al.  Preoperative MRI predicts outcome of temporal lobectomy . Neurology . 1995;;45:1358-1363.
33 +
Paillas JE, Gastaut H, Sedan R, et al.  Longterm results of conventional surgical treatment for epilepsy . Surg Neurol . 1983;;20:189-193.
34 +
Wingkun EC, Awad IA, Luders H, Awad C.  Natural history of recurrent seizures after resective surgery for epilepsy . Epilepsia . 1991;;32:851-856.
35 +
Dodrill CB, Hermann BP, Rausch R, Chelune GJ, Oxbury S.  Neuropsychological testing for assessing prognosis following surgery for epilepsy . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . 2nd ed. New York, NY: Raven Press; 1993;: 263-271.
36 +
Saykin AJ, Stafiniak P, Robinson LJ, Sperling MR, Gur RC, O'Connor MJ.  Language before and after temporal lobectomy . Epilepsia . 1995;;36:1071-1077.
37 +
Stafiniak P, Saykin AJ, Sperling MR, et al.  Acute naming deficits following dominant temporal lobectomy . Neurology . 1990;;40:1509-1512.
38 +
Chovaz CJ, McLachlan RS, Derry PA, Cummings AL.  Psychosocial function following temporal lobectomy . Seizure . 1994;;3:171-176.
39 +
Vickrey BG, Hays RD, Engel J Jr, et al.  Outcome assessment for epilepsy surgery: the impact of measuring health-related quality of life . Ann Neurol . 1995;;37:158-166.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Hauser WA, Hesdorffer DC. Epilepsy: Frequency, Causes, and Consequences . New York, NY: Demos Publications; 1990;.
2 +
Dikmen S, Morgan SF.  Neuropsychological factors related to employability and occupational status in persons with epilepsy . J Nerv Ment Dis . 1980;;168:236-240.
3 +
Rodin E, Rennick P, Dennerll R, Lin Y.  Vocational and educational problems of epileptic patients . Epilepsia . 1972;;13:149-160.
4 +
Elwes RD, Marshall J, Beattie A, Newman PK.  Epilepsy and employment: a community based survey in an area of high unemployment . J Neurol Neurosurg Psychiatry . 1991;;54:200-203.
5 +
Johnston SC, Horn JK, Valente J, Simon RP.  The role of hypoventilation in a sheep model of epileptic sudden death . Ann Neurol . 1995;;37:531-537.
6 +
Smith DF, Baker GA, Dewey M, Jacoby A, Chadwick DW.  Seizure frequency, patient perceived seizure severity, and the psychosocial consequences of intractable epilepsy . Epilepsy Res . 1991;;9:231-241.
7 +
Sperling MR, Saykin AJ, Roberts DF, French JA, O'Connor MJ.  Occupational outcome after temporal lobectomy for refractory epilepsy . Neurology . 1995;;45:970-977.
8 +
Taylor DC.  Psychiatric and social issues in measuring the input and outcome of epilepsy surgery . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . New York, NY: Raven Press Inc; 1987;: 485-503.
9 +
Engel J Jr, Shewmon AD.  Who should be considered a surgical candidate . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . 2nd ed. New York, NY: Raven Press; 1993;:23-34.
10 +
Bengzon ARA, Rasmussen T, Gloor P, Dussault J, Stephens M.  Prognostic factors in the surgical treatment of temporal lobe epileptics . Neurology . 1968;;18:717-731.
11 +
Bonis A.  Long-term results of cortical excisions based on the stereotaxic investigation in severe drug resistant epilepsies . Acta Neurochir . 1980;;30 ( (suppl) ):55-66.
12 +
Cahan L, Sutherling WW, McCullough M, Rausch R, Engel J, Crandall PH.  Review of the 20-year UCLA experience with surgery for epilepsy . Clev Clin Q . 1984;;51:313-318.
13 +
Dodrill CB, Wilkus RF, Ojemann GA, et al.  Multidisciplinary prediction of seizure relief from cortical resection surgery . Ann Neurol . 1986;;20:2-12.
14 +
Elwes RD, Dunn G, Binnie CD, Polkey CE.  Outcome following resective surgery for temporal lobe epilepsy . J Neurol Neurosurg Psychiatry . 1991;; 54:949-952.
15 +
Falconer MA, Serafetinides EA.  A follow-up study of surgery in temporal lobe epilepsy . J Neurol Neurosurg Psychiatry . 1963;;26:154-165.
16 +
Goldring S, Gregorie EM.  Surgical management of epilepsy using epidural recordings to localize the seizure focus . J Neurosurg . 1984;;60:457-466.
17 +
Guldvog B, Loyning Y, Hauglie-Hanssen E, Flood S, Bjornaes H.  Surgical treatment for partial epilepsy among Norwegian adults . Epilepsia . 1994;; 35:540-553.
18 +
Guldvog B, Loyning Y, Hauglie-Hanssen E, Flood S, Bjornaes H.  Surgical treatment for partial epilepsy among Norwegian children and adolescents . Epilepsia . 1994;;35:554-565.
19 +
Jensen I.  Temporal lobe epilepsy: types of seizures, age, and surgical results . Acta Neurol Scand . 1976;;53:335-357.
20 +
King DW, Flanigin HF, Gallagher BB, et al.  Temporal lobectomy for partial complex seizures: evaluation, results, and 1-year followup . Neurology . 1986;;36:334-339.
21 +
Mizrahi EM, Kellaway P, Grossman RG, et al.  Anterior temporal lobectomy and medically refractory temporal lobe epilepsy of childhood . Epilepsia . 1990;;31:302-312.
22 +
Rasmussen TB.  Surgical treatment of complex partial seizures: results, lessons, and problems . Epilepsia . 1983;;24( (suppl 1) ):S65-S76.
23 +
Rougier A, Dartigues J, Commenges, D, Claverie B, Loiseau P, Cohadon F.  A longitudinal assessment of seizure outcome and overall benefit from 100 cortectomies for epilepsy . J Neurol Neurosurg Psychiatry . 1992;;55:762-767.
24 +
Van Buren JM, Ajmone-Marsan C, Mutsuga N, Sadowsky D.  Surgery of temporal lobe epilepsy . Adv Neurol . 1975;;8:155-181.
25 +
Walczak TS, Radtke RA, McNamara JO, et al.  Anterior temporal lobectomy for complex partial seizures . Neurology . 1990;;20:413-418.
26 +
Sperling MR, O'Connor MJ, Saykin AJ, et al.  A non-invasive protocol for anterior temporal lobectomy . Neurology . 1992;;42:416-422.
27 +
Saykin AJ, Robinson LJ, Stafiniak P, et al.  Neuropsychological effects of temporal lobectomy: acute changes in memory, language and music . In: Bennett T, ed. Neuropsychology of Epilepsy . New York, NY: Plenum Publishing Corp; 1992;:263-290.
28 +
Sperling MR, O'Connor MJ.  Comparison of depth and subdural electrodes in recording temporal lobe seizures . Neurology . 1989;;39:1487-1504.
29 +
Engel J Jr.  Outcome with respect to epileptic seizures . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . New York, NY: Raven Press; 1987;: 553-571.
30 +
Sperling MR, Saykin AJ, Glosser G, Moran M, French JA, O'Connor MJ.  Predictors of outcome after anterior temporal lobectomy: the intracarotid amobarbital test . Neurology . 1994;;44:2325-2330.
31 +
Sperling MR, Wilson G, Engel J Jr, Babb TL, Phelps M, Bradley W.  Magnetic resonance imaging in intractable partial epilepsy: correlative studies . Ann Neurol . 1986;;20:57-62.
32 +
Berkovic SF, MacIntosh AM, Kalnins RM, et al.  Preoperative MRI predicts outcome of temporal lobectomy . Neurology . 1995;;45:1358-1363.
33 +
Paillas JE, Gastaut H, Sedan R, et al.  Longterm results of conventional surgical treatment for epilepsy . Surg Neurol . 1983;;20:189-193.
34 +
Wingkun EC, Awad IA, Luders H, Awad C.  Natural history of recurrent seizures after resective surgery for epilepsy . Epilepsia . 1991;;32:851-856.
35 +
Dodrill CB, Hermann BP, Rausch R, Chelune GJ, Oxbury S.  Neuropsychological testing for assessing prognosis following surgery for epilepsy . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . 2nd ed. New York, NY: Raven Press; 1993;: 263-271.
36 +
Saykin AJ, Stafiniak P, Robinson LJ, Sperling MR, Gur RC, O'Connor MJ.  Language before and after temporal lobectomy . Epilepsia . 1995;;36:1071-1077.
37 +
Stafiniak P, Saykin AJ, Sperling MR, et al.  Acute naming deficits following dominant temporal lobectomy . Neurology . 1990;;40:1509-1512.
38 +
Chovaz CJ, McLachlan RS, Derry PA, Cummings AL.  Psychosocial function following temporal lobectomy . Seizure . 1994;;3:171-176.
39 +
Vickrey BG, Hays RD, Engel J Jr, et al.  Outcome assessment for epilepsy surgery: the impact of measuring health-related quality of life . Ann Neurol . 1995;;37:158-166.

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