Monthly Case

An 18-year-old man suffers from partial epilepsy since early school years. Epilepsy is characterized by 2-3 automotor (= complex partial) seizures per month. In the past years, the patient was treated with four different antiepileptic drugs, however without any significant impact on seizure frequency. His epilepsy was caused by left-sided hippocampal sclerosis, i.e. a scar in mesio-temporal structures.

The patient reported several relevant limitations in his social life, including swimming and obtaining a driving license. In addition, he felt – one year before final school exams – some impairment in his cognitive capacities.

In spring 2013, the patient presented the first time in our epilepsy outpatient clinic. History and MRI finding suggested to timely evaluate the patient for possible epilepsy surgery. Some weeks later, video-EEG-monitoring proved that the patient’s typical seizures originate in left mesio-temporal structures. As video-EEG findings were congruent with MRI pathology, we recommended left anterior temporal lobe resection. We advised the patient that pharmacological antiepileptic treatment presumably will not result in sustained seizure freedom. The patient consented surgery, that was performed 2 weeks later, in May 2013, by our neurosurgical cooperation partners in the Charité.

One year after temporal lobe resection, the patient was re-assessed with multimodal diagnostic tools. He was completely seizure free since the operation, neuropsychology did not detect any deficits following resection.

In spring 2014, that patient successfully made his final school exams, in autumn 2014 he will start to study at university. The patient himself in particular appreciates his independence, he swims on his own and will acquire his driving license in the next weeks.

While pharmacological treatment of epilepsies follows a symptomatic approach, simply preventing or suppressing the next seizures, epilepsy surgery is a causal treatment approach. Temporal lobe resection in patients with hippocampal sclerosis results in seizure freedom in more than 70% of cases. After 2 years of postoperative seizure freedom antiepileptic drugs may be reduced and eventually tapered. If patients with partial epilepsy do not respond to two antiepileptic drugs, evaluation for epilepsy surgery should be considered. The younger the patients are at the time of operation, the better is social outcome.

Cases of the months before