Intractable epilepsy due to meningitis: results of surgery and pathological findings

Between 1986 and 1992, among a total of 668 craniotomies performed for intractable epilepsy, 13 1.9 patients had a presumed aetiology of a previous episode of meningitis. Twelve were investigated with chronic electrocorticography with subdural electrodes which showed mesial temporal onset in eight, regional temporal onset in three and bilateral diffuse onset in one. One patient underwent corpus callosotomy and 12 anterior temporal lobectomy ATL 6L, 6R. The pathology in the resection cases was hippocampal sclerosis in six and gliosis in six. Mean length of follow up was 3 years range 1-6 years. Ten of the 12 83 ATL patients were seizure free six off medications. Two ATL patients and the callosotomy patient were significantly improved. It is concluded that in patients where the presumed aetiology of intractable epilepsy is meningitis and widespread damage may therefore be expected, this does not necessarily indicate