(Kiosk 3) Functional Impairment Following Amygdalohippocampectomy for Complex Partial Seizures

Case Diagnosis: 58 year old right hand dominant female who presented to inpatient rehabilitation after left amygdalohippocampectomy for left mesial temporal lobe epilepsy.

Case Description or Program Description: Three years prior to presentation, the patient was rear ended in a motor vehicle collision and developed nocturnal focal onset impaired awareness seizures within weeks. She was trialed on several anti-epileptic medications but continued to have frequent breakthrough seizures.

Setting: Inpatient Rehabilitation

Assessment/Results: She subsequently underwent evaluation for surgical intervention given failure of medical therapy for refractory seizures that had been classified as progressive and functionally debilitating. Imaging demonstrated left hippocampal sclerosis, and hypometabolism of left mesial temporal lobe. After extensive work-up, she had a left amygdalohippocampectomy for left mesial temporal lobe epilepsy. She tolerated the operation well and was discharged to an acute inpatient rehabilitation facility due to impairments in cognition, safety awareness, and language.

Discussion (relevance): Complex partial seizures that are refractory to medical management are difficult to treat and amygdalohippocampectomies have been shown to be an effective way to treat focal seizures that are refractory to medical management. Amygdalohippocampectomy can lead to complete cessation of seizure activity in over two-thirds of patients; which in turn results in better quality of life. Following the surgery, however, it is common for deficits to arise such as verbal memory impairment which is typically worse after left-sided resections, compared to verbal impairments after right-sided resections.

Conclusions: Amygdalohippocampectomies have been shown to be an effective intervention for refractory focal seizures, but patients may develop verbal deficits postoperatively.