Clinical Outcome of Radiating Multiple Subpial Transections Alone for Drug Resistant Epilepsy After More Than 5 Years Follow-Up

Objective: Multiple subpial transection (MST) is a possible surgical treatment for patients with epileptogenic foci located in eloquent cortical areas. Commonly, it is performed in addition to other surgical techniques. In some cases, however, it is performed alone. We report the clinical results of 12 patients who received solely radiating MST with a minimal follow-up of 5 years.

Methods: All patients who underwent a surgical intervention between 2003 and 2012 for refractory epilepsy were studied. Among them, 12 had radiating MST (rMST) as the only surgical treatment with a follow-up of at least 5 years.

Results: At 5-year follow-up, 50% of the patients were Engel class I, 25% were Engel class II, 0% were Engel class III, and 25% were Engel class IV. At last follow-up, 8 patients (67%) were free of seizures, 1 patient (8%) had an over 75% decrease, and 3 patients (25%) did not improve after the procedure. None of the Engel I patients had seizure recurrence, and those belonging to an intermediate class improved during follow-up, in some cases in association with an antiepileptic drug modification. Two patients (17%) had a minor transient complication, and 1 patient (8%) had a minor permanent complication.

Conclusions: rMST performed alone gives a favorable outcome in 75% of the patients at a minimum 5-year follow-up with few minor complications. This procedure appears to be effective even with a prolonged follow-up in drug resistant epilepsy with the epileptogenic foci located in eloquent areas.