Objective:

Background:

Frontal lobe epilepsy (FLE) is the second most common type of focal epilepsy and among the most challenging to diagnose and treat. Although surgical resection offers potential seizure freedom, outcomes vary, and high-quality data from low- and middle-income countries are scarce. This study aimed to describe a cohort of patients with FLE undergoing epilepsy surgery and identify factors associated with favorable outcomes.

Design/Methods:

A retrospective observational study was conducted on 40 consecutive patients with drug-resistant FLE who underwent resective epilepsy surgery at a center in Bogotá, Colombia, between 2016 and 2024. Data on clinical features, neuroimaging, surgery, and histopathology were collected. Surgical outcomes were classified using the Engel Epilepsy Surgery Outcome Scale; Engel class I or II was considered favorable. Bivariate analyses were performed to identify predictors of good outcomes. 

Results:

Median age at surgery was 25.5 years (IQR: 14.8–34.8); 67.5% were male and 92.5% right-handed. Semiological group 1 (motor/premotor cortex) was most common (75%). MRI revealed focal cortical dysplasia or gliosis in 12.5% each; 37.5% had normal imaging. Histopathology confirmed dysplasia in 17.5%, gliosis in 12.5%, and was normal in 37.5%. At median 29.7 months follow-up, 57.5% achieved favorable outcomes. Normal histopathology was significantly associated with poor outcomes (p = 0.003). Trends toward better outcomes were seen in patients with standard resections (p = 0.053) and identifiable lesions, though not statistically significant.

Conclusions:

Epilepsy surgery for FLE is feasible and safe in middle-income countries and can yield outcomes similar to global reports. These results underscore the importance of early referral, detailed semiological analysis, and lesion detection for surgical planning in drug-resistant FLE.