Epilepsy surgery outcomes in temporal lobe epilepsy with a normal MRI

Michael L. Bell, Satish Rao, Elson L. So, Max Trenerry, Noojan Kazemi, S. Matt Stead, Gregory Cascino, Richard Marsh, Fredric B. Meyer, Robert E. Watson, Caterina Giannini, Gregory A. Worrell

Research output: Contribution to journalArticlepeer-review

150 Scopus citations


Purpose: To determine the long-term efficacy of anterior temporal lobectomy for medically refractory temporal lobe epilepsy in patients with nonlesional magnetic resonance imaging (MRI). Methods: We identified a retrospective cohort of 44 patients with a nonlesional modern "seizure protocol" MRI who underwent anterior temporal lobectomy for treatment of medically refractory partial epilepsy. Postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Noninvasive preoperative diagnostic factors potentially associated with excellent surgical outcome were examined by univariate analysis in the 40 patients with follow-up of >1 year. Results: Engel class I outcomes (free of disabling seizures) were observed in 60% (24 of 40) patients. Preoperative factors associated with Engel class I outcome were: (1) absence of contralateral or extratemporal interictal epileptiform discharges, (2) subtraction ictal single photon emission computed tomography (SPECT) Coregistered to MRI (SISCOM) abnormality localized to the resection site, and (3) subtle nonspecific MRI findings in the mesial temporal lobe concordant to the resection. Discussion: In carefully selected patients with temporal lobe epilepsy and a nonlesional MRI, anterior temporal lobectomy can often render patients free of disabling seizures. This favorable rate of surgical success is likely due to the detection of concordant abnormalities that indicate unilateral temporal lobe epilepsy in patients with nonlesional MRI.

Original languageEnglish (US)
Pages (from-to)2053-2060
Number of pages8
Issue number9
StatePublished - Sep 2009


  • Epilepsy surgery
  • Nonlesional-MRI
  • Partial seizures
  • Temporal lobe

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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