Background: Surgery for frontal lobe epilepsy often has poor results, likely owing to incomplete resection of the epileptogenic zone.
Objective: To present our experience with a series of patients manifesting two different anatomo-electro-clinical patterns of refractory orbito-frontal epilepsy, necessitating different surgical approaches for resection in each group.
Methods: Eleven patients with refractory epilepsy involving the orbito-frontal region were consecutively identified over three years, in whom stereoelectroencephalography identified the epileptogenic zone. All patients underwent pre-operative evaluation, stereoelectroencephalography, and post-operative magnetic resonance imaging. Demographic features, seizure semiology, imaging characteristics, location of the epileptogenic zone, surgical resection site, and pathological diagnosis were analyzed. Surgical outcome was correlated with type of resection.
Results: Five patients exhibited 'orbito-frontal-plus frontal epilepsy,' with the epileptogenic zone consistently residing in the frontal lobe; following surgery, four were free of disabling seizures (Engel I) and one improved (Engel II). The remaining six patients had multi-lobar epilepsy, with the epileptogenic zone located in the orbito-frontal cortex associated with the temporal polar region ("orbito-frontal-plus temporal polar epilepsy"). Following surgery, all six patients were free of disabling seizures (Engel I). Pathology confirmed focal cortical dysplasia in all patients. We report no complications or mortalities in this series.
Conclusion: Our findings highlight the importance of differentiating between orbito-frontal-plus frontal and orbito-frontal-plus temporal polar epilepsy in patients afflicted with seizures involving the orbito-frontal cortex. For identified cases of orbito-frontal-plus temporal polar epilepsy, a multi-lobar resection including the temporal pole may lead to improved post-operative outcomes with minimal morbidity or mortality.
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