ORIGINAL ARTICLE   

Journal of Neurosurgical Sciences 2017 June;61(3):277-82

DOI: 10.23736/S0390-5616.16.02843-5

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Outcome after temporal lobectomy in patients with medically-refractory mesial temporal epilepsy in Iran

Ali A. ASADI-POOYA ^{1, 2, 3}, Seyed M. RAKEI ⁴, Ahmad KAMGARPOUR ⁴, Mousa TAGHIPOUR ^{1, 4}, Nahid ASHJAZADEH ^{1, 2}, Ali RAZMKON ^{1, 4}, Zahra ZARE ⁵, Mohammad H. BAGHERI ⁶ ✉

¹ Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; ² Department of Neurology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; ³ Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA; ⁴ Department of Neurosurgery, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; ⁵ Department of Radiology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; ⁶ Medical Imaging Research Center, Department of Radiology, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

BACKGROUND: Epilepsy surgery has been proved to be feasible and cost-effective in developing countries. In the current paper, we discussed the outcome of patients with mesial temporal lobe epilepsy (MTLE) and medically-refractory seizures who had surgery at our center in Shiraz, Iran.
METHODS: Patients aged 18 years and older with refractory MTLE and mesial temporal sclerosis operated at Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran from May 2009 through December 2011 were enrolled. Presurgical evaluation included clinical history, neurological examination, 2-hour video-EEG recording, and 1.5-T MRI. All patients were submitted to standard temporal lobectomy at the side determined by MRI and video-EEG.
RESULTS: Twenty-two patients (12 women and 10 men) underwent surgery between May 2009 and December 2011. All patients were followed postoperatively for at least 12 months (mean=24.8±7.7 months; minimum=12 months; maximum=36 months). At the last follow-up visit, 18 patients (81.8%) had a good outcome (15 patients [68.2%] had Engel class 1 and three others had Engel class 2). The total cost of presurgical evaluation and epilepsy surgery at our center was less than $500.
CONCLUSIONS: Resources are limited for the vast majority of medically-refractory patients with epilepsy who live in the developing countries. However, it is feasible to select good surgical candidates for anterior temporal lobectomy relying on the clinical history and examination, MRI and interictal EEG. Broader application of epilepsy surgery should be encouraged in countries with limited financial resources.

KEY WORDS: Epilepsy, temporal lobe - Outcome assessment, health care - Developing countries