Temporal lobe epilepsy surgery and preoperative factors predictive of postoperative outcome: retrospective analysis of 143 cases.
OBJECTIVE
To evaluate the long-term outcome of temporal lobe epilepsy (TLE) surgery with dipole localization and to analyze the preoperative factors predicting a satisfactory postoperative outcome of the patients.


METHODS
A total of 143 patients, who underwent TLE surgery with dipole localization combined with magnetic resonance imaging between 1999 and 2001 and were followed up for at least 1 year, were enrolled in this retrospective analysis of clinical, electrophysiological, neuroimaging and surgical factors to determine the independent predictors for the clinical outcome of the patients.


RESULTS
During the follow-up with a mean duration of 27.5 months, 70.6% (101) of the patients were found to be completely seizure- free or with only aura (Class I), and 14.0% (20) had only rare seizures (Class II, fewer than three seizures per year), which resulted in satisfactory seizure control in 84.6% of the cases. In addition, obvious improvement was achieved in 10.5% (15) of the cases (Class III, at least an 75% seizure reduction), while 4.9% (n=7) failed to respond to the surgical treatment (Class III, less than 75% seizure reduction), showing a rate of unsatisfactory seizure control of 15.4%. The preoperative factors contributing to the prediction of good seizure control (P <0.05) included early onset of epilepsy (before the age of five years), presence of complex partial seizure as a predominant seizure type, low seizure frequency, unilateral structural abnormality detectable on magnetic resonance images, absence of cortical dysplasia, restrained epileptic activity as detected by dipole localization, and agreement of pathological findings of the lesion with epileptogenic focus.


CONCLUSIONS
The surgical treatment with the help of dipole localization results in satisfactory clinical outcome of the patients, and some preoperative factors in relation to the clinical findings and diagnosis may predict excellent postoperative outcome.
Xu
Ru-xiang
RX
Institute of Neuroscience of PLA, Zhujiang Hospital, First Military Medical University, Guangzhou 510282, China. zjxrx@163.net
Liu
Zhi-liang
ZL
Zhang
Xin-wei
XW
Zhou
Gu-lan
GL
Ke
Yi-quan
YQ
Peng
Ping
P
Tang
Yan-ping
YP
Zhou
Jia
J
D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies; D016896:Treatment Outcome