Prognostic value of concordant seizure focus localizing data in the selection of temporal lobectomy candidates.
This study was performed to test the hypotheses that (a) resection of the temporal lobe epileptic focus, amenable to noninvasive as opposed to invasive localization, is associated with superior seizure outcome and (b) that quadruple (versus lesser degrees of) concordance of seizure focus localizing data predicts superior seizure-free outcome. Eighty-three patients underwent invasive (subdural-EEG) and/or noninvasive (video/scalp-EEG, SPECT, PET, MRI, neuropsychological testing) evaluation. All patients underwent anterior temporal lobectomy and amygdalohippocampectomy (ATL/AH) and seizure outcome was assessed at minimum one-year follow-up. At 34.8 +/- 2.5 months following ATL/AH, outcome was superior for patients in whom the seizure focus was amenable to noninvasive compared to invasive localization (80% versus 40% seizure-free, X2 = 14.03, p < 0.05). Seizure outcome was superior for patients with quadruple, compared to all lesser degrees of, concordance of seizure focus localizing data (85% versus 51% seizure-free, X2 = 7.34, p < 0.05). Post-ATL/AH, seizure outcome is superior in patients (1) harboring an epileptic focus amenable to noninvasive localization and (2) with quadruple concordance of seizure focus localizing data. These findings support the development of temporal lobectomy selection criteria including up to four invasive and/or noninvasive concordant seizure focus localizing techniques.
Labiner
David M
DM
Department of Neurology, University of Arizona College of Medicine, Tucson, AZ, USA.
Weinand
Martin E
ME
Brainerd
Charles J
CJ
Ahern
Geoffrey L
GL
Herring
Anne M
AM
Melgar
Miguel A
MA
D000293:Adolescent; D000328:Adult; D000679:Amygdala / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D038481:Anterior Temporal Lobectomy / Q000592:standards*; D002648:Child; D003952:Diagnostic Imaging / Q000592:standards / Q000706:statistics & numerical data*; D004569:Electroencephalography / Q000592:standards / Q000706:statistics & numerical data; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D013223:Statistics as Topic / Q000592:standards; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014055:Tomography, Emission-Computed / Q000592:standards / Q000706:statistics & numerical data; D015899:Tomography, Emission-Computed, Single-Photon / Q000592:standards / Q000706:statistics & numerical data; D016896:Treatment Outcome