partial seizures

[bz]

At what point do you think surgery should be considered for temporal lobe epilepsy?  Is there any way of knowing which center has the most accurate results of pre-surgical evaluation?

Thank you

[barbara to pain and lortab]

I was just diagnosed with temporal lobe partial epilepsy after almost one year of thinking it was alcohol withdrawal. I would not even consider surgery. I would go back to drinking before taking brain surgery. So far the Neurontin and Klonopin work well in reducing and almost completely stopping the seizures.

[CCF Neuro[P] MD, RPS]

Dear BZ:

As you probably know, when one has temporal lobe epilepsy, the seizure activity is usually refractatory to medications.  When this happens, one begins to think about surgery.  One needs to be evaluated by a epilepsy surgery center (my bias).  What we look for is 1) if the temporal lobe epilepsy is focal and limited to one lobe or not, 2) are there MRI changes in the specific temporal lobe (we want to see hippocampal sclerosis), 3) best if language will not be compromised, 4) which temporal lobe is memory best preserved (we hope the opposite temporal lobe to the one that is epileptogenic), 5) if the PET scan shows hypometabolism over the suspect temporal lobe, 6) if MRS is done, if there is a decreased NAA/choline ratio in the affected temporal lobe, and 7) if the patient wants to have the surgery.  When everything lines up, then there is about a 80-85% success rate.  Why go to an epilepsy surgery center? because if things don't line up perfectly, they are best to evaluate the little or big differences and are able to direct the patient with more confidence to surgery or something else.

I hope this helps.

Sincerely,

CCF Neuro MD