title: Long term outcome of temporal lobe epilepsy surgery: analyses of 140 consecutive patients.
abstract: OBJECTIVE
  To analyse the long term results of temporal lobe epilepsy surgery in a national epilepsy surgery centre for adults, and to evaluate preoperative factors predicting a good postoperative outcome on long term follow up.
  
  
  METHODS
  Longitudinal follow up of 140 consecutive adult patients operated on for drug resistant temporal lobe epilepsy.
  
  
  RESULTS
  46% of patients with unilateral temporal lobe epilepsy became seizure-free, 10% had only postoperative auras, and 15% had rare seizures on follow up for (mean (SD)) 5.4 (2.6) years, range 0.25 to 10.5 years. The best outcome was after introduction of a standardised magnetic resonance (MR) imaging protocol (1993-99): in unilateral temporal lobe epilepsy, 52% of patients became seizure-free, 7% had only postoperative auras, and 17% had rare seizures (median follow up 3.8 years, range 0.25 to 6.5 years); in palliative cases (incomplete removal of focus), a reduction in seizures of at least 80% was achieved in 71% of cases (median follow up 3.1 years, range 1.1 to 6.8 years). Most seizure relapses (86%) occurred within one year of the operation, and outcome at one year did not differ from the long term outcome. Unilateral hippocampal atrophy with or without temporal cortical atrophy on qualitative MR imaging (p < 0.001, odds ratio (OR) 5.2, 95% confidence interval (CI) 2.0 to 13.7), other unitemporal structural lesions on qualitative MR imaging (p < or = 0.001, OR 6.9, 95% CI 2.2 to 21.5), onset of epilepsy before the age of five years (p < 0.05, OR 2.9, 95% CI 1.2 to 7.2), and focal seizures with ictal impairment of consciousness and focal ictal EEG as a predominant seizure type (p < 0.05, OR 3.4, 95% CI 1.2 to 9.1) predicted Engel I-II outcome. Hippocampal volume reduction of at least 1 SD from the mean of controls on the side of the seizure onset (p < 0.05, OR 3.1, 95% CI 1.1 to 9.2) also predicted Engel I-II outcome.
  
  
  CONCLUSIONS
  Outcome at one year postoperatively is highly predictive of long term outcome after temporal lobe epilepsy surgery. Unitemporal MR imaging abnormalities, early onset of epilepsy, and seizure type predominance are factors associated with good postoperative outcome.
authors.affiliation: Department of Neurology, University of Kuopio, Finland. leena.jutila@kuh.fi
authors.forename: L
authors.initials: L
authors.lastname: Jutila
authors.forename: A
authors.initials: A
authors.lastname: Immonen
authors.forename: E
authors.initials: E
authors.lastname: Mervaala
authors.forename: J
authors.initials: J
authors.lastname: Partanen
authors.forename: K
authors.initials: K
authors.lastname: Partanen
authors.forename: M
authors.initials: M
authors.lastname: Puranen
authors.forename: R
authors.initials: R
authors.lastname: Kälviäinen
authors.forename: I
authors.initials: I
authors.lastname: Alafuzoff
authors.forename: H
authors.initials: H
authors.lastname: Hurskainen
authors.forename: M
authors.initials: M
authors.lastname: Vapalahti
authors.forename: A
authors.initials: A
authors.lastname: Ylinen
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010166:Palliative Care; D011184:Postoperative Period; D011300:Preoperative Care