Monthly Case

A 43-year-old female patient suffers from partial epilepsy with automotor (= complex partial) seizures for 25 years (seizure frequency, 4-5 per month). Seizures are characterized by impaired consciousness and oral automatisms. Seizures are preceded by epigastric auras. In the past years, the patient was administered eight different antiepileptic drugs that eventually failed to control her seizures. Brain MRI reveals right hippocampal sclerosis that presumably is the cause for the patient’s epilepsy. In pre-surgical assessment, video-EEG-monitoring recorded several habitual seizures with onset pointing to right temporo-mesial structures. As all findings were congruent, we recommended right anterior temporal lobe resection.

However, the patient refused resection, though the chance for post-operative seizure freedom was highly favourable. Reasons for refusal remained elusive.

An analysis from the university hospital Bonn on long-term seizure outcome after epilepsy surgery revealed that in the last 20 years the fraction of patients refusing resection has increased to up to 20% (Bien et al. 2013 JNNP).

We see it as our duty to inform patients explicitly on the risks of injuries and even worse perils accompanying repeated epileptic seizures. These risks significantly overwhelm those of the operative procedure.

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