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within the temporal lobe. MRI allows a better assessment of the pathology pre-operatively and the extent of removal post-operatively, both of which will influence seizure outcome and cognitive outcome. Cascino and his colleagues have demonstrated that there may be dual pathology in the temporal lobe, which could account for the failure of lesionectomy in this area. Pathology and outcome are clearly related, with the exception of cortical dysplasia. The resective procedure seems to make little difference to seizure outcome and overall results from anterior temporal lobectomy and selective amyg-dalo-hippocampectomy, summarized in two reviews, were almost identical (Table 34.5). The results in children tend to be better because these series contain a higher proportion of "positive" lesions.

Behavioral problems in patients with uncontrolled temporal lobe epilepsy (TLE) are well documented and they will often improve or disappear if seizure control is good.

Psychosis supervening upon chronic epilepsy is usually a late event. Temporal lobe surgery can produce a schizophreniform psychosis, often associated with left-sided resections, but this is rare - less than 1% in the authors' material. A depressive illness, more often associated with right-sided operations, occurs in 10-15% of our patients. It may be related to the size of the resection, being rare after amygdalo-hippocampectomy and in children.

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