Initial Experience of Different Surgical Techniques in Temporal Lobe Epilepsy in Nepal

Basant Pant, MD, PhD
Department of Neurosurgery
Kathmandu Model Hospital
Kathmandu, Nepal

Prabin Shrestha, MBBS
Department of Neurosurgery
Kathmandu Model Hospital
Kathmandu, Nepal

Pranay Shrestha, MBBS
Department of Neurosurgery
Kathmandu Model Hospital
Kathmandu, Nepal

Kazunori Arita, MD
Department of Neurosurgery 
Hiroshima University  school of Medicine
Hiroshima, Japan

Tomokatsu Hori, MD
Department of Neurosurgery 
Tokyo Women's Medical University
Tokyo, Japan

Abstract

    An initial experience of different surgical techniques in intractable temporal lobe epilepsy (TLE) secondary to mesial temporal sclerosis (MTS) is presented. We resorted to surgery in 4 cases of TLE when all other means of non-surgical treatment failed. There were 3 males and 1 female with the history of seizure ranging from 9 to 13 years. All patients were on an adequate dose of multidrug regimes despite which they were having frequent seizure incapacitating daily life. All patients underwent interictal scalp electroencephalography (EEG), and magnetic resonance imaging (MRI) including fluid attenuated inversion recovery (FLAIR) technique. None had sphenoidal or other invasive EEG techniques. One patient had single photon emission computerized tomography (SPECT) and video telemetry. In all cases MTS was found on the right side, presumed to be the non-dominant side by handedness. None of our patients were subjected to Wada test for language determination. On the surgical technique, a standard temporal lobectomy was done in 1, tailored temporal lobectomy in 1 and selective amygdalohippocampectomy (SAH) in 2 cases. There was no mortality or morbidity in this series and all patients are leading an active life. All patients were asked to continue with preoperative medication and gradual tapering of the dose was planned. Postoperative follow up ranged from 2 and a half years for the initial case to 8 months for the latest case. Surgical results included complete remission in 3 cases (Engel class I) and 1 patient with SAH had 1 episode of seizure 3 months following surgery (Engel class II).  It is hard to draw any conclusions, given the  small number of patients and the  relatively short duration of follow-up, but an attempt is made to assess the feasibility of applying different surgical techniques in our setting. Since the preoperative work-up, intraoperative monitoring and postoperative follow-up needs to be tailored in the context of available resources, we discuss the need to critically judge different surgical techniques best suitable to our setting.

    Key words: epilepsy, intractability, surgery, technique