Introduction: Epilepsy affects 1% of the population, with close to 3 million people affected in the United States and 60 million people worldwide. As many as 30–40% of these patients have medically intractable epilepsy. Many of these patients benefit from resective epilepsy surgery. Based on a randomized controlled trial (RCT), the American Academy of Neurology, the American Epilepsy Society, and the American Society of Neurological Surgeons practice parameters recommended surgery as the treatment of choice for medically refractory temporal lobe epilepsy, which is the most common cause of refractory epilepsy. Resective epilepsy surgery remains underutilized, however, as a treatment option for epilepsy and in the United States less than 1% of patients with pharmacoresistant epilepsy are referred to epilepsy centers. As stated by Engel, “For patients who are referred, the average delay from onset of epilepsy to surgery is more than 20 years – too late for many to avoid a lifetime of disability or premature death.” Epilepsy syndromes and resective epilepsy surgery: The most common type of epilepsy surgery is anterior temporal lobe resection. The syndrome of mesial temporal lobe epilepsy (MTLE) is characterized by an increased incidence of complex febrile convulsions or other predisposing insults within the first 5 years of life, and onset of seizures in mid-to-late childhood. Most patients have auras described as an epigastric rising sensation or fear, followed by behavioral arrest, staring, and oroalimentary automatisms. Contralateral dystonic posturing of the upper extremity may also occur. Patients with seizures from the dominant temporal lobe may have postictal dysphasia. Secondarily generalized seizures may also occur. Temporal lobe seizures may remit during adolescence, but they often became medically resistant. Interictal behavioral disturbances and depression can also occur. There is evidence that the pathology of MTLE may be progressive, and earlier onset of seizures is associated with greater hippocampal volume loss and cognitive deficits; seizure frequency and epilepsy duration are associated with hippocampal volume loss, as well.
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