Improving the Selection of Temporal Lobectomy Candidates Through the Use of Multiple Subdural Electroencephalographic Prognostic Parameters

Long-term subdural video-EEG monitoring was performed in a series of patients with medically intractable complex partial seizures to test the hypothesis that multiple subdural EEG parameters could be used to better predict seizurefree outcome after temporal lobectomy. The five subdural EEG parameters examined were the existence of evidence of ictal subdural EEG evidence of seizure activity before the onset of clinical seizure activity (ECOT), the time for interhemispheric propagation time of an electrocorticographic seizure (IHPT), unilateral seizure onset, evidence for fast spike trains (FST), and lack of frontal lobe desynchronization. In our series of 99 consecutive patients with refractory temporal lobe epilepsy, a significant correlation was found between these five factors and seizure freedom after surgery. This result provides the neurosurgeon and epileptologist with a quantitative tool capable of predicting seizure freedom after surgery based on quantifiable subdural?EEG parameters. The capability of these parameters to predict seizure freedom may allow the patient and epileptologist to anticipate results and the need for any future clinical intervention for seizure control.