Esclerosis temporal mesial: paradigma de la epilepsia de resolución quirúrgica: 2da. parte / Temporary mesial sclerosis: Surgical resolution epilepsy paradigm 2nd. Part*

ABSTRACT

Objective. To describe the Mesial Temporal Lobe Sclerosis (MTS), in relation to its anatomical, clinical, iconographic, neurophysiologic, neuro psychologic, and surgical aspects, in reference to the epilepsy cases that needed a surgical resolution. Additionally, it’s realized a statistical analysis of our series and its results.Material and methods. From the series of 469 patients (115 adults and 354 children) operated on between 1989 and 2007, at National Pediatrics . Dr. Juan Garrahan, FLENI, Dr. Cosme Argerich, and Prof. Dr. R. Rossi Hospitals; who harbored RefractoryEpilepsy ; were analyzed 91 cases (19,4%) with the diagnosis of MTS; 38 patients belong to the pediatric group and 53 were adults. Results. The results were evaluated by the Engel score. Applying this classification, our population of patients showed thenext pattern of distribution: 69 (75,8%) are in Engel’s class IA, from this group, 36 (52,2%) are children, and 33 (47,8%), adults; 4 adults patients;( 4,4%) are in Engel’s class IB, 3 patients (3,3%) in Engel’s class IC; 1 (in Engel’s class ID(1,1%); 4 adults in Engel’s class IIA (4,4%); 5 in Engel’s class IIB (5;5%) and 3 (3,3%) in Engel’s class IVA; from then, one patient was a child, and underwent the implantation of VNS, the rest were adults. One adult patient committed suicide, one year after surgery (was in Engel’s class IA). One patient is on his first post operative year,and then couldn’t been included in statistical analysis, because follow up wasn’t enough. Conclusion. The MTS is the paradigm of Refractory Epilepsy inthe adult population, and in the pediatric subgroup involved a significant percentage: the presurgical evaluation must be exhaustive for adequate selection of cases. The extent of resection should be done with high degree of selectivity. The early diagnosis and treatment can obtain a high index of good results without ictal phenomena and the absence of necessity of antiepileptic drugs.