Surgery for temporal lobe epilepsy in Semarang, Indonesia: The first 56 patients with follow up longer than 12 months

Until October 2005, surgery were performed for 76 intractable temporal lobe epilepsy patients. Among them, 56 patients had follow-up of 12-76 months. The patients consisted of 35 males and 21 females, age between 3-38 year-old. Magnetic Resonance Imaging diagnoses were hippocampal sclerosis in 50 patients, temporal lobe tumor in 3 patients, hemispheric hemiatrophy, calcified hippocampal lesion and normal imaging one patient each. Intracranial subdural grid EEG was performed in the patient with normal imaging. Psychological evaluation was performed in all patients, while Wada test was performed on patients with left-sided lesion. All patients underwent anterior temporal lobectomy. Seizure free (Engel’s I) was seen on 46 patients (82%). Six patients (11%) had less than 2 seizures per year (Engel’s II). Seizure decreased by more than 75% (Engel’s III) in 4 patients (7%). There was a trend with increased number of patients with Engel’s II and III with longer duration of seizures. Complications were extradural empyema in 5 patients (9%), depression in 2 patients (4%), transient hemiparesis in one patient (2%). Thirty-one patients were able to withdraw the antiepileptic drugs. In conclusion, epilepsy surgery can achieve good results in developing countries. Neurology Asia 2006; 11 : 31 – 36 Address correspondence to: Dr Zainal Muttaqin, Department of Neurosurgery, Medical Faculty, Diponegoro University, Semarang, Indonesia. INTRODUCTION Despite availability of modern antiepileptic drugs (AEDs), up to 30-40% of epilepsy patients continue to have seizures1,2 and approximately half of these are potential candidates for surgery.3 Complex partial seizures with seizure focus mostly in the temporal lobe made up most of these intractable cases.4 Surgery to abolish seizures is recommended for mesial temporal lobe epilepsy (MTLE), which is possibly the most common form of human epilepsy and the most refractory to AEDs.5-7 Approximately 65% of patients are seizure free after surgery, while another 21% improved.8,9 The first randomized controlled trial on patient with refractory epilepsy10 has shown that in TLE, surgery is superior to optimized AED therapy, with more than 64% seizure free with surgery, and 8% with medical therapy. In TLE the surgical procedure is a standardized anterior temporal lobectomy including amygdalohippocampectomy. All pre-surgical evaluation is directed to determining the epileptogenic temporal lobe. Magnetic resonance imaging (MRI) is currently the best imaging modality for patient with partial epilepsy.11-14 Visual MRI is able to identify mesial temporal sclerosis (MTS) in 8090% of patients, and nearly 90% patients will be seizure free after anterior temporal lobectomy.1519 Quantitative MRI studies, showing unilateral volume loss, further improves the sensitivity of detecting epileptogenic temporal lobe.20,21 The volumetric MRI is particularly useful in patients with bilateral hippocampal atrophy, subtle unilateral atrophy, and symmetric appearing hippocampi.21,22 Assuming an epilepsy prevalence rate similar to elsewhere at 0.5%, there are 1.1 million Indonesians with epilepsy in the 220 million populations, 276,000 to 386,000 are likely to be refractory to AEDs, and 138,000 to 193,000 may benefit from surgery. Epilepsy surgery started on July 1999 at Diponegoro University Hospital in Semarang, Central Java, Indonesia. Since then, surgery has been performed on 84 patients, partial epilepsy in 78 and generalized epilepsy in 6. Among partial epilepsy cases, 76 were TLE receiving a standard anterior temporal lobectomy and 56 of them had follow-up of more than 12 months. This is a review of the 56 patients.