Prognostic factors in the surgical treatment of medically intractable epilepsy associated with mesial temporal sclerosis.
OBJECTIVE
To assess the prognostic factors determining seizure remission after temporal lobectomy for intractable epilepsy associated with mesial temporal sclerosis (MTS) at pathology.


METHODS
The clinical and investigative features of 116 consecutive patients who had temporal lobe surgery for drug-resistant epilepsy and MTS at pathology were assessed using actuarial statistics and logistic regression analysis.


RESULTS
At a median follow-up of 63 months the probability of achieving at least a 1-year period of continuous seizure freedom was 67%. Factors contributing to a favourable outcome were interictal EEG localization to the operated lobe and the absence of secondarily generalized seizures. These were also selected in the multivariate analysis, although at lower statistical significance (P=0.08 and 0.09, respectively). Perinatal complications were associated with a significantly worse outcome but overall, complicated febrile convulsions and congruent neuropsychological deficits were not significantly predictive variables.


CONCLUSIONS
The present findings may aid in the non-invasive presurgical assessment of patients with intractable TLE and clinical and neuroimaging evidence of MTS.
Hennessy
M J
MJ
Epilepsy Centre, Kings College Hospital, Denmark Hill, London SE5, Department of Biostatistics and Computing, Institute of Psychiatry, de Crespigny Park, London SE5. michael@hennessy72.fsnet.co.uk
Elwes
R D
RD
Rabe-Hesketh
S
S
Binnie
C D
CD
Polkey
C E
CE
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D004351:Drug Resistance; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009483:Neuropsychological Tests; D011379:Prognosis; D011612:Psychosurgery / Q000379:methods*; D012307:Risk Factors; D012598:Sclerosis / Q000150:complications / Q000473:pathology; D012720:Severity of Illness Index; D013702:Temporal Lobe / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
D000927:Anticonvulsants