Factors predicting outcome of surgery for intractable epilepsy with pathologically verified mesial temporal sclerosis.
OBJECTIVE
To examine the subgroup of patients with medically intractable epilepsy receiving temporal lobectomies who have pathologically verified mesial temporal sclerosis (MTS) and to determine the relation of demographic and clinical factors, results of diagnostic testing, and details of the surgical procedure with prognosis for achieving control of seizures.


METHODS
All patients receiving surgical treatment for intractable epilepsy between 1991 and 1998 at the University of Washington were reviewed. There were 118 patients who met inclusion criteria of adequate pathological analysis showing MTS without a progressive process and a minimum of 1-year follow-up.


RESULTS
Only personal history of status epilepticus demonstrated significant (p = 0.0276) prediction of outcome, increasing the risk of surgical failure. No other factors were significant predictors of outcome, including history of febrile seizures, possible etiologic factors, EEG, magnetic resonance imaging (MRI) or neuropsychological testing results, or extent of resection.


CONCLUSIONS
Many factors that have been previously described to predict favorable outcome in the overall group of patients receiving temporal lobe resections for intractable epilepsy are, in fact, predictors of MTS and lose their predictive value when the subgroup of patients with confirmed MTS is examined. Neurosurgical treatment of MTS can be very effective even in the presence of significant etiologic factors, or of bilateral or extratemporal abnormalities on EEG or MRI.
Hardy
Steven G
SG
Department of Neurology, Regional Epilepsy Center, University of Washington School of Medicine, Seattle, Washington, USA.
Miller
John W
JW
Holmes
Mark D
MD
Born
Donald E
DE
Ojemann
George A
GA
Dodrill
Carl B
CB
Hallam
Danial K
DK
D000328:Adult; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011379:Prognosis; D011612:Psychosurgery; D012598:Sclerosis; D013226:Status Epilepticus / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome