Le but de ce travail est d’exposer, au moyen d’une revue de la littérature, les résultats que la chirurgie permet d’obtenir, en termes de contrôle des crises, ainsi que de bénéfices secondaires, sur l’épilepsie pharmaco-résistante.

Les données de la littérature permettent d’affirmer que la chirurgie du lobe temporal permet de faire cesser toute crise dans près de 70 p. 100 des cas (de 50 à 93 p. 100 des cas selon les séries). La chirurgie de résection temporale est la seule dont l’efficacité est attestée par une étude prospective randomisée. Les résultats obtenus après chirurgie du lobe frontal font état de 60 p. 100 de guérison. L’hémisphérotomie fait également partie des procédures chirurgicales curatives, elle permet d’obtenir un arrêt des crises dans près de 60 p. 100 des cas. La radiochirurgie stéréotaxique semble procurer des résultats proches de ceux obtenus après résection temporale.

La callosotomie est une technique palliative, utilisée souvent chez l’enfant, et qui permet d’obtenir une réduction significative du nombre de crises dans 65 à 85 p. 100 des cas. Les données relatives aux résultats de la transsection sous-piale multiple sont d’interprétation délicate, mais concluent à une diminution de fréquence des crises dans 50 à 70 p. 100 des cas.

La chirurgie, en particulier temporale, constitue donc un traitement souvent efficace de l’épilepsie pharmaco-résistante.

Surgical treatment of drug-resistant epilepsy is being performed in a growing number of adults and children. The objective of this report is to review and evaluate the published literature related to the outcome of epilepsy surgery. Surgical procedures were classified as “curative”, which included temporal and extratemporal resections, as well as hemispherotomy and stereotactic radiosurgery, and as “palliative”, which mainly included callosotomy and multiple subpial transections.

Data obtained from the literature suggest that after temporal lobe surgery, 68 percent of the adult patients, on average, are seizure-free. This result may vary, according to the authors, from 50 to 93 percent. One randomized controlled study concludes that 58 percent of patients treated surgically become seizure-free, compared to only 8 percent in the group of patients who do not receive surgery. This suggests that temporal lobe surgery is an efficient treatment of drug-refractory temporal lobe surgery. Seizure outcome is similar in the pediatric population. Studies of frontal lobe surgery report that an average of 60 percent of patients are seizure-free after surgery, in adults as well as in children. These results may vary considerably, depending on how the seizure outcome is defined. Too few studies are available to allow for an evaluation of parietal or occipital lobe surgery. Hemispherotomy is mostly performed in the pediatric population. Studies of this procedure report that 60 percent of patients become seizure free after surgery, whereas 80 percent are improved in terms of seizure outcome and in terms of behavior. Stereotactic radiosurgery may be performed in case of hypothalamic hamartoma, and in some cases of temporal lobe epilepsy. In this later case, the reported results are similar to those obtained with temporal resections.

Seizure outcome after corpus callosotomy is difficult to summarize, because of the many variations, according to the authors, of the definition of a good or poor seizure outcome. However, it can be stated that 65 to 85 percent of patients achieve a significant reduction in overall seizure frequency. The best reduction in seizure frequency is achieved in patients with atonic. Reported percentages of patients who benefit from multiple subpial transection, varies between 50 and 70 percent.

In conclusion, our report shows that temporal resection is an efficient and scientifically validated treatment of drug-resistant temporal lobe epilepsy. Extra-temporal resections, hemispherotomy, and palliative surgery often allow cure of epilepsy, or a decrease of seizure frequency, however, prospective studies of these surgical procedures are needed.