502 Clinical Outcomes for Treatment of Peri-Rolandic Epilepsy. (April 2023)

• Record Type: Journal Article
• Authors: Lee, Anthony T.; Spiedel, Benjamin; Knowlton, Robert C.; Rao, Vikram; Chang, Edward
• Is Part Of: Neurosurgery. Volume 69(2023)Supplement 1
• Page Start: 111
• Page End: 111
• Publication Date: 2023-04
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/neu.0000000000002375_502
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : INTRODUCTION: Treatment of epileptogenic foci within the eloquent peri-Rolandic region (pre- and post-central gyri) is challenging. Advances in surgical techniques and implantable neuromodulation devices have broadened the available treatment options. METHODS: We retrospectively studied all consecutive patients who underwent intracranial seizure monitoring from 2013 to 2021. We studied demographic and imaging variables, stimulation results, seizure outcomes, and neurological function at various stages of recovery. RESULTS: 22 patients encompassing 25 procedures were included in this study. 12 of the patients had non-lesional MRIs with surgical intervention involving the dominant hemisphere. 9 patients underwent peri-Rolandic resections, and 11 patients received peri-Rolandic RNS. The rest had a combination of non-peri-Rolandic resection, multiple subpial transection, and peri-Rolandic RNS. When comparing resection against RNS cohorts, more patients who elected for resection had failed prior surgical interventions. Although most resection patients had a neurological deficit at discharge (78% for resection vs 0% for RNS), those who received resection had better rates of seizure control (Engel I at last follow-up: 78% for resection vs 27% for RNS). Almost all patients with neurological deficits experienced significant functional recovery over time. CONCLUSIONS: Resection of peri-Rolandic seizure foci can lead to excellent outcomes with neurological morbidity that improves over time. Treatment selection should be tailored based on risk-benefit analysis and patient preference.