54. Long term surgical results in supplementary motor area epilepsy surgery

Abstract

Objective To show surgical results in SMA epilepsy patients in two reference centers in Mexico City. Material and methods Retrospective study (1999–2014), of 52 patients submitted to lesionectomy and/or corticectomy of the SMA guided by electrocorticography (ECoG). We describe the clinical, neurophysiological, neuroimaging and pathological findings. The Engel scale was used to classify surgical outcome. Descriptive statistics, t Student, Friedman, Kruskal Wallis and Chi-square tests were used. Results 52 patients, mean age at epilepsy onset 26.3 years, mean preoperative monthly seizure frequency 14. Etiology: 28 (53.8%) low-grade tumors, 17 (32.7%) cortical dysplasia and 7 (13.5%) cavernomas. At a mean follow-up of 5.7 (1–10) years, 32 patients (61%) were Engel I, 16 (31%) Engel II and 4 (8%) Engel III. Overall seizure reduction was significant (p = 0.001). The absence of post-surgical early seizures, and lesional etiology were related with Engel I (p = 0.05). Twenty-six (50%) patients had complications in postoperative period all of which resolved completely. Conclusions Surgery of SMA epilepsy guided by ECoG, using a multidisciplinary and multimodality approach is a safe and feasible procedure showing good seizure control, moderate morbidity and no mortality. Significance Surgery of SMA epilepsy guided by ECoG is effective (61%, Engel I) and safe to long term.