[Surgical outcome of temporal lobe epilepsy]. / Wyniki operacyjnego leczenia padaczki skroniowej.

Results of the surgical treatment of temporal lobe epilepsy--Authors present their own experience in the surgical treatment of temporal lobe epilepsy. 403 patients were operated upon. The age of the patients was not limited. The beginning of the epilepsy was in most cases in early childhood, however the conservative treatment was continued for a very long time, usually over 10 years. The modern diagnostic tools, especially MRI, make it possible to diagnose the temporal epileptic focus more often, than previously, especially in cases with morphological substrate. Temporal lobectomy with amygdalo-hippocampectomy was performed. The follow-up was at least 3 years after surgery. Outs of 343 patients examined in this period 175 were cured, without seizures after surgery. Next 61 patients had no more than 2 small attacks a year. So in 69% of patients the result was very good or satisfactory. The neuropsychological investigation revealed that in most patients the IQ improved. Their quality of life improved markedly according to their own opinion.

[The comparison of ketamine with methohexital and thiopental in the intraoperative EEG in drug-resistant epilepsy]. / Porównanie ketaminy z methohexitalem i thiopentalem w aktywacji sródoperacyjnej elektrokortykografii, w lekoopornej padaczce.

UNLABELLED: The acute (ECoG) was examined in 291 patients with intractable epilepsy, without structural brain lesion--from 1971 to 1997. Temporal lobectomy was performed in 198 cases and extratemporal (frontal, parietal or occipital) in remaining 93 cases to achieve seizure control. Epileptic foci was activated during acute ECoG by i.v. administration of ketamine (154 cases) or short-acting barbiturates--methohexital (110 cases) and thiopental (27 cases). RESULTS: Ketamine significantly more often caused ECoG identified electrographic seizures than methohexital: p = 0, 00001 or thiopental, which in no cases resulted in seizures. Also electrographic seizures occurred more frequently after administration of ketamine in patients with the extratemporal seizure focus localisation in comparison with temporal focus (p < 0.05). Electrographic seizures provoked after administration of ketamine improved the localisation of the area to be resected, more often in extratemporal epileptic foci. CONCLUSIONS: The results of our investigations indicate that ketamine more effectively activated epileptic focus than short-acting barbiturates.

[Surgical treatment of epilepsy: current status and results of own observations]. / Operacyjne leczenie padaczki--stan obecny i wyniki w swietle wlasnych spostrzezen.

New diagnostic possibilities make possible a more precise localization of epileptogenetic foci and surgical treatment of epilepsy is associated presently with minimal risk. This was the reason of a surge of interest in recent years even in those countries where this method has not been used. In our country operations for chronic refractory epilepsy have been performed since over 35 years and the gathered experience is sufficient to reach conclusions about the results. The results depend in a certain degree on the location of the focus and the surgical possibility of its removal. In about 50% of the cases cure was effected, and in 15% improvement was achieved near cure. Considering that the treated patients had long-standing and refractory epilepsy with very frequent seizures the results of surgical removal of epileptogenic focus were very good. The authors believe that patients with chronic, focal and refractory epilepsy should be treated surgically, and conservative treatment without considering this possibility is erroneous.

[Incidence of brain tumors in cases of chronic epilepsy treated surgically]. / Wystepowanie guzów mózgu w przypadkach chronicznych padaczek leczonych operacyjnie.

An incidence of tumors of the brain as a cause of drug-resistant epilepsy have been analysed. The analysis included patients operated for epilepsy at the Department of Neurosurgery, Medical Academy in Warsaw between 1987 and 1991. Malignant tumors were found in 21 out 85 patients (24.7%) treated surgically, 22.4% were benign tumors, and 52.9%--lesions of cicatricial character. The most frequent malignant tumor was fibrillary astrocytoma, noted in 57.1% of cases. Neurological examination has revealed discrete symptoms only in 2 out of 21 patients. CT scans have showed non-characteristic focus of decreased density in 12 patients (57.1%). Differentiation of tumor-produced epilepsy and those due to other focal lesions could not be made with the clinical course of seizures and EEG records. Actually, an incidence of tumors of the brain causing seizures refractory to pharmacologic treatment is increasing. Not characteristic clinical course and EEG records as well as CT scans are the main causes of delays in the surgery.

[Callosotomy in treatment of severe epilepsy]. / Przeciecie ciala modzelowatego w leczeniu ciezkich postaci padaczki.

The authors present palliative therapy of severe epilepsy, i.e. callosotomy. Experimental studies and numerous clinical trials indicate possible use of this technique. However, there are no precise indications and contraindications to the treatment with this technique. The authors discuss own experience with 8 epileptic patients refractory to preservative therapies. These patients were treated surgically with anterior callosotomy. Small number of patients and relatively short period of the follow-up do not allow more general conclusions to be drawn. However, in 3 out of 4 operated patients an improvement was noted within one year or more, including one case of significant improvement. No improvement was seen in one case. The authors will collect other cases. However, it is worth emphasizing that callosotomy is performed in Poland, already.