Evaluation of resective surgery for seizure control for patients with drug resistant focal epilepsy

Abstract Background Epilepsy is a neurological disorder affecting approximately 70 million people worldwide, characterized by seizures. Around one-third of patients do not respond to medical treatment. Resective surgery is an established treatment for drug-resistant epilepsy, with success depending on a comprehensive presurgical evaluation. This evaluation ensures the appropriate selection of candidates and accurate identification of the epileptogenic zone for safe resection. The assessment includes clinical history, interictal EEG, high-resolution MRI, neuropsychological evaluation, and additional techniques like functional imaging and intracranial monitoring. The alignment of these methods is crucial for a successful outcome; this study aims to assess the outcome of resective surgery in patients with drug-resistant focal epilepsy. It was conducted between October 2021 and October 2023; 35 patients with drug-resistant focal epilepsy underwent resective surgical intervention, including lesionectomy, anterior temporal lobectomy, and selective amygdalohippocampectomy. Preoperative evaluations involved seizure semiology, interictal EEG, and MRI. Postoperative outcome was evaluated using the ENGEL classification (Class I: Free of disabling seizures, Class II: Rare disabling seizures (almost seizure-free), Class III: Worthwhile improvement, Class IV: No worthwhile improvement) and changes in anti-seizure medications (ASMs). Results The study included 35 patients for whom resective surgery was done as follows: 24 underwent lesionectomy, 4 had anterior temporal lobectomy, and 7 had selective amygdalohippocampectomy. According to the ENGEL classification, 25 patients achieved Class I, and 10 achieved Class II. A significant reduction in the number of anti-seizure medications was observed in the follow-up period following surgery compared to preoperative use. Conclusion Resective surgery in drug-resistant focal epilepsy is effective and results in improved outcomes as regards epileptic seizure freedom.