Journal Article

Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome

J. Janszky, I. Janszky, R. Schulz, M. Hoppe, F. Behne, H. W. Pannek and A. Ebner

in Brain

Published on behalf of The Guarantors of Brain

Volume 128, issue 2, pages 395-404
Published in print February 2005 | ISSN: 0006-8950
Published online January 2005 | e-ISSN: 1460-2156 | DOI: http://dx.doi.org/10.1093/brain/awh358
Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome

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Temporal lobe epilepsy (TLE) accompanied by hippocampal sclerosis (HS) is the type of epilepsy most frequently operated on. The predictors for long-term seizure freedom after surgery of TLE-HS are unknown. In this study, we aimed to identify prognostic factors which predict the outcome 6 months and 2, 3 and 5 years after epilepsy surgery of TLE-HS. Our working hypothesis was that the prognostic value of potential predictors depended on the post-operative time interval for which the assessment was made. We included 171 patients (100 females and 71 males, aged 16–59 years) who had undergone presurgical evaluation, including video-EEG, who had had MRI-defined HS, and who had undergone temporal lobectomy. We found that secondarily generalized seizures (SGTCS) and ictal dystonia were associated with a worse 2-year outcome. Both these variables together with older age and longer epilepsy duration were also related to a worse 3-year outcome. Ictal limb dystonia, older age and longer epilepsy duration were associated with long-term surgical failure evaluated 5 years post-operatively. In order to determine the independent predictors of outcomes, we calculated multivariate analyses. The presence of SGTCS and ictal dystonia independently predicted the 2-year outcome. Longer epilepsy duration and ictal dystonia predicted the 3-year outcome. Longer epilepsy duration (P = 0.003) predicted a poor 5-year outcome. Conclusively, predictors for the long-term surgical results of TLE with HS are different from those variables that predict the short-term outcome. Epilepsy duration is the most important predictor for long-term surgical outcome. Our results strongly suggest that surgery for TLE-HS should be performed as early as possible.

Keywords: epilepsy surgery outcome; prognosis; duration; generalized tonic-clonic seizures; ictal dystonia; AED = anti-epileptic drugs; CI = confidence interval; HS = hippocampal sclerosis; IED = interictal epileptiform discharges; OR = odds ratio; ROC = receiver operating characteristic; SGTCS = generalized tonic-clonic seizures; TLE = temporal lobe epilepsy

Journal Article.  7089 words.  Illustrated.

Subjects: Neurology ; Neuroscience

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