Observation on the surgical efficacy of bilateral temporal lobe epilepsy confirmed by stereoelectroen-cephalography
Objective To explore the methods and efficacy of surgical treatment of bilateral temporal lobe epilepsy(SEEG-BTLE)confirmed by stereoelectroencephalography(SEEG).Methods A total of 13 patients with SEEG-BTLE were treated at the Department of Neurosurgery,the Second Affiliated Hospital of Army Military Medical University from June 2019 to March 2023.Among them,5 cases with obvious lateralization of the origin of epileptic seizures underwent unilateral anterior temporal lobe resection,6 cases who had no obvious lateralization of the origin of epileptic seizures or refused resection underwent SEEG-guided radiofrequency thermocoagulation.There were 2 cases undergoing neuromodulation,including 1 case of deep brain stimulation(DBS)and 1 case of vagus nerve stimulation(VNS).In both cases,the origin of epileptic seizures could not be obviously lateralized.The clinical data and efficacy of patients were retrospectively analyzed.The efficacy of resection and radiofrequency thermocoagulation was evaluated using the Engle grading standard,with grades Ⅰ to Ⅱ representing good efficacy and grades Ⅲ to Ⅳ representing poor efficacy.Neuromodulation efficacy was evaluated according to the McHugh grading standard.Grades Ⅰ to Ⅱ indicated good efficacy and grades Ⅲ to Ⅴ indicated poor effect.Results Five patients who underwent unilateral anterior temporal lobectomy were followed up for 14 to 45 months.There were 3 cases of Engle grade Ⅰ and 2 cases of Engle grade Ⅲ.Memory decline occurred in 2 cases.The follow-up time of 6 patients who underwent radiofrequency thermocoagulation ranged from 6 to 31 months.One case was Engle grade Ⅰ,1 was Engle grade Ⅱ,2 were grade Ⅲ,and 2 were grade Ⅳ.One patient had memory decline.The two patients who received DBS and VNS had follow-up times of 35 and 38 months respectively,and both were McHugh class ⅢA.Conclusions Preliminary research shows that individualized principles should be used to treat SEEG-BTLE.The efficacy of lesion resection in unilateral temporal lobe is relatively better,the efficacy of radiofrequency thermocoagulation is acceptable,and neuromodulation therapy may have certain efficacy.
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