Bitemporal Intractable Epilepsy: Could It Be Surgically Treatable?

Background: The goal of this study is to retrieve the attention to the treatment opportunities for this cohort of intractable bitemporal epilepsy patients who in most cases are not considered optimal candidates for surgery. Objectives: The purpose of this study is to demonstrate that electrophysiologically guided precise surgeries on both temporal lobes can have a beneficial effect on seizures without additional cognitive decline. Methods: Twenty-one intractable bitemporal epilepsy patients [13 men, 8 women, mean age 21 years (range 6–43), mean duration of illness 17 years (range 3–31), frequency of seizures 6–55 per month] underwent stereotactic cryosurgery on both temporal lobes guided by chronic and intraoperative depth electrode studies. Results: Class I (‘free of disabling seizures’) outcome was achieved for 11/21 (52%), class II (‘rare seizures’) for 6/21 (29%), and class IV (‘no worthwhile improvement’) for 4/21 (19%) patients. No worsening of seizure or clinically significant cognitive or memory impairments were observed in this cohort of patients (follow-up 5–10 years). Conclusions: The minimally invasive precise surgeries on both temporal lobes confined to the removal/lesion of just the brain tissue that exhibited epileptic activity can have a beneficial effect on seizure frequency and severity without additional devastating declines in intelligence, learning and memory.