title: Long-term follow-up after temporal lobe resection for lesions associated with chronic seizures.
abstract: A follow-up study was conducted on 60 patients who had standard en bloc anterior temporal lobe resection, including mesio-temporal structures, as treatment for temporal lobe lesions associated with chronic, medically intractable seizures. Lesions were identified as glial tumors, hamartomas, or vascular malformations. Long-term outcome was assessed in terms of seizure frequency and certain psychosocial sequelae. Seizure onset occurred at an average age of 15 years (median = 13.5 years), and patients experienced seizures for an average of 13 years prior to surgery. The mean time of follow-up was 8.4 years post-surgery (median = 6 years). The Kaplan-Meier curve at median follow-up showed a seizure-free rate of 80%. Late seizure recurrence was documented for three patients; two had been seizure free for 10 years and one for 15 years after surgery before re-onset of seizures in the absence of tumor recurrence. A prolonged history of seizures prior to surgery was associated with a poorer seizure outcome (p = 0.06), suggesting that secondary epileptogenesis at sites distant to the lesion may develop with years of uncontrolled seizures. There was a low tumor recurrence rate of 3.3% (two cases). The psychosocial outcome was generally good, with 67% working or engaged in educational studies, and improvement noted in 59% of cases for one or more of the psychosocial factors investigated. This study confirms that anterior temporal lobe resection for temporal lesions associated with chronic seizures is a successful treatment with a high seizure-free rate following surgery and good psychosocial outcome.
authors.affiliation: Division of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Eliashiv
authors.forename: S
authors.initials: S
authors.lastname: Dewar
authors.forename: I
authors.initials: I
authors.lastname: Wainwright
authors.forename: J
authors.initials: J
authors.lastname: Engel
authors.forename: I
authors.initials: I
authors.lastname: Fried
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D001927:Brain Diseases / Q000150:complications* / Q000601:surgery*; D001932:Brain Neoplasms / Q000150:complications* / Q000601:surgery; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000150:complications / Q000601:surgery; D006222:Hamartoma / Q000150:complications / Q000601:surgery; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000601:surgery; D008297:Male; D012640:Seizures / Q000209:etiology* / Q000503:physiopathology; D012917:Social Adjustment; D013702:Temporal Lobe / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome