Comparing outcomes of mesial temporal lobectomy surgery in refractory epilepsy versus maximum medical therapy among patients attending neurology clinic at King Abdullah Medical City, Makkah, Saudi Arabia

Background: Epilepsy, commonly, refractive epilepsy is a debilitating disorder that affects the quality of life, leads to frequent hospital admissions, and problems in carrying out day-to-day activities. This study aims to compare the outcomes of mesial temporal lobectomy for refractory epilepsy against maximum medical therapy. Methods: A retrospective case series study was conducted on patients attending the Neurology Clinics at King Abdullah Medical City between 2019 and 2023. The study included patients diagnosed with refractory epilepsy who underwent mesial temporal lobectomy. The study included eight patients with a median age of 22.0 years. Results: The number of seizures significantly decreased from 6.5 (IQR: 4.0-9.3) before surgery to 1.0 (IQR: 0.8-2.0) after surgery (p = 0.014). Hospital admissions due to seizures reduced from 1.0 (IQR: 1.0-2.0) before surgery to 0.0 (IQR: 0.0-0.3) after surgery (p = 0.015). The number of antiseizure medications (ASM) medications decreased from 3.0 (IQR: 3.0-3.0) to 2.0 (IQR: 1.8-2.0) following surgery (p = 0.018). Conclusion: Mesial temporal lobectomy improves seizure control, reduces hospital admissions due to seizures, and decreases the need for ASM in patients with refractory epilepsy. These findings suggest surgical intervention offers superior outcomes regarding seizure control and quality of life for patients who do not respond adequately to maximum medical therapy.