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Title: Epilepsy surgery in Belgium, the experience in Gent
Authors: Boon, P ×
Vandekerckhove, T
Achten, E
Thiery, E
Goossens, L
Vonck, K
D'Have, M
Van Hoey, G
Vanrumste, Bart
Legros, B
Defreyne, L
De Reuck, J #
Issue Date: Dec-1999
Publisher: Acta Medica Belgica
Series Title: Acta Neurologica Belgica vol:99 issue:4 pages:256-265
Abstract: Between January 1992 and July 1998, 320 patients Mere presurgically evaluated for medically refractory epilepsy at the University, Hospital of Cent. All patients underwent a comprehensive presurgical evaluation, including extensive neurological history and examination, video-EEG monitoring of interictal EEG and habitual seizures, and optimum magnetic resonance (MR). hi a large subgroup of these patients, a comprehensive neuropsychological examination and interictal (FDC)-F-18-PET were performed. Subsequently, a bilateral carotid angiography and intracarotid amytal procedure (Wada-test) were planned in 49 patients to establish hemispheric language dominance and bilateral memory function. After proper selection, 23 patients underwent invasive video-EEG monitoring with intracranial implantation of parenchymal and/or subdural al electrodes to further document the area of seizure onset. Front the initial group of 320 potential surgical candidates, 75 patients (42 males, 33 females) with mean age of 29 pears (range:2 months - 55 years) and mean duration of uncontrolled seizures of 15 years (range : 2 weeks-38 years) eventually underwent a surgical procedure. Sixty of 75 patients were on high dose antiepileptic polytherapy. Optimum MR detected structural al abnormalities, confirmed to a limited brain ar ea, ill 71 patients. These abnormalities were of space-occupying nature in 31 cases; an atrophic lesion was suspected in 39 patients; a combination of space-occupying and atrophic lesion was seen ill I case. Stuctural al abnomalities were most frequently located in the temporal lobe (n = 53) and the frontal lobe (n = 10). Video-EEG monitoring documented complex partial seizures in 67 patients with occasional secondary, generalisation in 32, Most patients had complex partial seizures of of temporal lobe as defined by clinical and EEG criteria. Two patients had only simple partial seizures. Ultimately, an area of seizure onset could be determined in all patients. Temporal lobectomy with hippocampectomy was the most commonly performed procedure (n = 42). In 13 patients, complete lesionectomies were performed for epileptogenic structural lesions; in and outside the temporal lobe. In 2 patients, only partial lesionectomies were possible; in 5 patients, only biopsies in combination with partial lesionectomies could be performed Anterior 2/3 callosotomy was performed in 4 patients and hemispherectomy was performed in 2 patients. Postsurgical seizure control, after average follow-up of 50 months (range: 12- 98 months) was excellent in 49 patients who became seizure-free. In these patients, antiepileptic therapy was tapered 2 years after surgery. Patients in whom only, biopsies or partial lesionectomies were performed have poor seizure control. Epilepsy surgery is a rewarding therapeutic alternative for patients with medically refractory fractory epilepsy. Comprehensive presurgical evaluation and epilepsy surgery provide excellent neurological, neurophysiologiacal, neuropsychological and imaging research opportunities.
URI: 
ISSN: 0300-9009
Publication status: published
KU Leuven publication type: IT
Appears in Collections:ESAT - STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics
Technologiecluster ESAT Elektrotechnische Engineering
Electrical Engineering (ESAT) TC, Technology Campus Geel
Electrical Engineering (ESAT) TC, Technology Campus Diepenbeek
× corresponding author
# (joint) last author

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