P.096 Effectiveness of palliative focal resective surgery in intracranial EEG confirmed multifocal intractable epilepsy in adult patients

Abstract

Background: Effectiveness of “palliative resections” of a dominant epileptogenic focus in adults with multifocal intractable epilepsy confirmed on intracranial EEG has rarely been reported. Methods: We retrospectively reviewed our database to identify patients who underwent focal resection after confirmation of multiple seizure foci on intracranial EEG. Results of presurgical investigations, intracranial EEG, procedures, complications and outcome were collected. Results: A total of 17 patients underwent palliative resection (8 left, 9 right). Preoperative MRI revealed malformations of cortical development in 6 patients, and MTS in 6 patients. Intracranial stereo EEG revealed 8 bilateral and 9 unilateral multifocal epileptogenic foci. Surgical procedures included anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy in 4 patients, ATL plus additional cortical resection in 7 patients, and extratemporal resection in 6 patients. One patient had dysphasia post ATL and a second patient had worsened cognitive dysfunction post extended frontal lobectomy. Favorable seizure outcome (Engel class I and II) was achieved in 10 patients (58.8%). Pathology revealed focal cortical dysplasia in 6 patients and hippocampal sclerosis in 5 patients. Conclusions: Palliative resection of a dominant epileptogenic focus confirmed by intracranial EEG is effective in carefully selected adult cases of intractable epilepsy, particularly in patients with lesional epilepsy.