Intracranial, Intraaxial, Space‐Occupying Lesions in Patients with Intractable Partial Seizures: An Anatomoclinical, Neuropsychological, and Surgical Correlation

Summary: : Fifty of ˜250 patients evaluated for intractable partial seizures were shown to have a space‐occupying lesion detected with radiographs and/or neuroimaging. Twenty‐eight males and 22 females had a mean age at seizure onset of 13 years and a mean duration of seizures of 11 years. All patients had closed‐circuit television with EEG monitoring and complete neurologic and neuropsychological assessment. Findings were correlated with lesion location and surgical data. Twenty‐seven lesions (54%) were located in the temporal lobe. Thirty‐five lesions (70%) were neoplastic. All patients with temporal lobe lesions had complex partial seizures, as did 74% of patients with extratemporal lesions. A good correlation between clinical seizure characteristics and lesion localization was found with the temporal, occipital, and frontal lesions but not with the parietal lesions. Sixty‐six percent of patients had focal interictal EEG findings. Lateralization corresponded to the side of the lesion in 64% and was localized to the region of the lesion in 30%. Lateralized ictal EEGs occurred in 58% of patients, corresponding with the side of the lesion in all but one patient. Abnormal findings on neuropsychological testing were congruent with lesion lateralization in 56% of patients and were localized to the region in 26%. Thirty‐nine of 47 patients who underwent a subtotal lobectomy to include the lesion are seizure‐free after ≫1 year of follow‐up, and five others are markedly improved.