Epilepsy due to gross destructive brain lesions

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Abstract
Eighty-eight patients with large destructive lesions involving more than 1 lobe of the brain and with focal epilepsy inadequately controlled by anticonvulsant medication have undergone craniotomy and extensive cortical resections from 1930 through 1960. There were 2 postoperative deaths. Detailed follow-up data on 85 of the remaining 86 patients cover periods from one to twenty-four years. The remaining 1 patient was lost to follow-up. The median follow-up period is six years. In 72 patients, 85%, the follow-up study is complete to the date of this analysis or to time of death (10 patients). Birth injury was clearly responsible for the brain lesion in 47 patients, or 54%. In 13 patients, or 15%, encephalitis or meningoencephalitis was responsible. Postnatal head injury or gunshot wound were the causes of lesions in 10 patients, or 11.5%. Hemispherectomy was carried out in 17 patients, with complete or nearly complete reduction in the seizure tendency in 15, or 88%. The remaining 71 patients had less extensive cortical excisions. Thirty-one, or 35%, of the total group of 88 patients have had no attacks since leaving the hospital, and an additional 8, or 9%, have become seizure-free after having had a few attacks during the early postoperative period. Thus, 44% of the group have had an essentially complete reduction of seizure tendency. In 24, or 27%, the operation resulted in a marked but incomplete reduction in seizure tendency; these patients have continued to have occasional attacks at intervals of months or years. In the remaining 32 patients, or 25%, there were lesser degrees of reduction in seizure tendency and the result was considered unsatisfactory. There were 52 patients treated by surgery in the decade 1951 through 1960, when the need to think in terms of large epileptogenic areas rather than discrete epileptogenic foci had become apparent. Operation made 27, or 52%, of these patients seizure-free and greatly reduced seizure tendency in another 15 patients, or 29 %. Thus a reasonably satisfactory result was produced in 81% of these 52 patients. Eighteen of the 88 patients underwent more than 1 operation. Seven of these 18, or 39%, became seizure-free after reoperation and 2, or 11%, had their seizure tendency greatly reduced. In most of the remaining 9 patients, there was some further reduction in seizure tendency but insufficient to convert an unsatisfactory into a satisfactory result.

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