Objectives: Bitemporal lobe epilepsy is commonly encountered in the evaluation of pharmacoresistant epilepsy. Yet the role of surgery in the management of these patients is unclear. This study evaluates the impact of surgery on seizure tendency and quality of life, as well as prognostic indicators in individuals with proven ictal onset bitemporal epilepsy.
Methods: Subjects comprised all patients who underwent temporal lobe surgery over a 10 year study period and had ictal onset bitemporal lobe epilepsy identified with intracranial electrode monitoring. Patients with extra-temporal seizure generators were excluded. Subjects were divided into a favourable or less favourable group based on the results of surgery on the seizure tendency.
Results: Eleven subjects were studied with a mean 5.9 years follow-up post-surgical. Six subjects constituted the favorable outcome group. Four had less favorable outcome and continued to have frequent seizures after surgery; although, three with less favorable seizure reduction subjectively reported improvement in quality of their life after surgery due to reduced seizure frequency and severity, and reduced medications. No single preoperative factor reached significant difference between the groups, including ictal EEG laterality, epilepsy duration, age at surgery, age at seizure onset, and mesial temporal atrophy.
Conclusions: Surgical resection is an important treatment option for medically intractable bitemporal epilepsy. The proportion of seizures arising from one temporal lobe is not reliable as a single indicator to prognosticate the results of surgery on the seizure tendency. Additionally, individuals who achieved only palliation by reducing the seizure frequency experienced quality of life improvement.