Epilepsy surgery for pathologically proven hippocampal sclerosis provides long-term seizure control and improved quality of life.
OBJECTIVE
To examine long-term seizure and quality-of-life outcome in a homogeneous group of patients after temporal lobectomy with pathologically proven hippocampal sclerosis (HS). Previous research has had limited follow-up (generally <2 years) and has grouped patients across multiple pathologies.


METHODS
Fifty consecutive patients were identified as having had a temporal lobectomy for the treatment of temporal lobe epilepsy at Royal Melbourne Hospital with pathologically proven HS and >or=2 years' follow-up. All patients were sent a postal survey concerning seizure activity, quality of life (QOLIE-89), and antiepileptic drug (AED) use. The mean follow-up was 5.8 years (range, 2-9.2).


RESULTS
The rate of complete postoperative seizure freedom was 82% at 12 months, 76% at 24 months, and 64% at 63 months (no further seizure recurrences observed after this time). A class I seizure outcome was achieved by 83.3% of patients. Patients with better seizure outcome had significantly better quality of life (Kendall's tau =-234, p < 0.01). Seizure recurrence was associated with a reduction in AED intake or absorption in five (29%) of 17 cases, including three of the five patients with a first seizure recurrence after 24 months after surgery.


CONCLUSIONS
Temporal lobectomy provides continued long-term seizure control in the majority of patients with HS. However, patients remain at risk of seizure recurrence >or=2 years after surgery. Long-term quality of life is dependent on seizure outcome.
Department of Neurology, Royal Melbourne Hospital, Vic, Australia.
Adrian J
AJ
Lowe
Efraim
E
David
Christine J
CJ
Kilpatrick
Zelko
Z
Matkovic
Mark J
MJ
Cook
Andrew
A
Kaye
Terence J
TJ
O'Brien
D000293:Adolescent; D000328:Adult; D004833:Epilepsy, Temporal Lobe / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011300:Preoperative Care; D011788:Quality of Life; D012598:Sclerosis / Q000150:complications / Q000473:pathology; D016896:Treatment Outcome