Manejo quirúrgico y Test de wada en la epilepsia refractaria del lóbulo temporal
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SUMMARY INTRODUCTION: with adecuate antiepilectic therapies; there are 40% patients with persisten crisis and 20% of them have any response to antiepilectic drugs. This patients have a refractary epilepsia almost produced by mesial sclerosis of temporal lobe. Surgery mough be a good alternative in these cases. OBJECTIVE: to describe the experience of Instituto Neurologico de Antioquia epilepsy surgery group in the evaluation of patients with intractable temporal lobe epilepsy, using Wada's test and surgical treatment. MATERIALS AND METHODS: a descriptive, prospective, longitudinal study was carried out from october 2001 to june 2005 in patients suffering from temporal lobe epilepsy which was refractory to medical treatment. These patients were studied by clinical neurological evaluation, magnetic resonance, videoEEG, neuropsychological, psychiatric evaluation, and Wada's test in order to evaluate cognitive functions, specially language and memory and also to quantify their functional reserve, to predict their cognoscitive risk, to be able to determine which patients were candidates to surgical treatment. For the post-surgical follow-up, Engel's classification was used. RESULTS: 85 patients suffering from intractable epilepsy were evaluated. 66 patients were operated on; from them 42 patients were suffering from mesial temporal lobe epilepsy. In the evaluation with the Wada's test, it was demonstrated that in patients suffering from MTLE, the language was dominant in the side collateral to the lesion in 45% of the patients, and for the memory in all patients. The functional reserve for the memory was higher than 50% in most of the patients. The frequency of the crisis in the post-surgical period was reduced in the patients who were operated on for temporal lobe epilepsy 91.8% of patients were under Engel I classification. CONCLUSIONS: a proper selection of the candidates for surgery by a defined protocol guarantees a good post surgical prognosis in relation to the control to the crisis. Wada's test is fundamental in the prediction of the cognoscitive risk.
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