A 45-year-old man with a 5-year history of focal epilepsy due to hippocampal sclerosis continues to have monthly disabling seizures despite trials of carbamazepine, levetiracetam, and lacosamide at adequate doses. MRI shows right hippocampal atrophy. He is evaluated for epilepsy surgery. Which procedure offers the highest chance of seizure freedom?
- A Anterior temporal lobectomy with amygdalohippocampectomy ✓
- B Vagus nerve stimulation
- C Corpus callosotomy
- D Multiple subpial transections
Correct answer: A. Anterior temporal lobectomy with amygdalohippocampectomy
Explanation
Anterior temporal lobectomy with amygdalohippocampectomy is the gold standard surgical treatment for drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis. Randomized trial data show seizure freedom in approximately 60-70% of patients at 1-2 years. Corpus callosotomy is palliative for atonic/drop attacks. Vagus nerve stimulation rarely achieves seizure freedom and is palliative. Multiple subpial transections are used for seizures in eloquent cortex. Standard neurology texts confirm resection offers the best outcome in this scenario.
Reference: Bradley's Neurology in Clinical Practice, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.