Survival analysis of the surgical outcome of temporal lobe epilepsy due to hippocampal sclerosis.
OBJECTIVE
Surgical results in patients with mesial temporal lobe epilepsy due to hippocampal sclerosis (MTLE/HS) are often reported in conjunction with other etiologies of TLE.


METHODS
We prospectively collected surgical outcome data for 2 to 11 years for 134 consecutive patients who specifically had MTLE and unilateral HS, according to magnetic resonance imaging (MRI) and confirmed by histopathology. Sixty-five had postoperative neuropsychological testing. Outcome was analyzed by using Engel's classification (a) through Kaplan-Meier estimated survival curves (as a function of the time to seizure recurrence), (b) as percentage of patients in each outcome class on a yearly basis, and (c) at the last updated follow-up.


RESULTS
Kaplan-Meier estimates of complete seizure freedom (Engel's class IA) for years 1, 2, 5, and 10 were 85%, 77%, 74%, and 66%, and of Engel's class I were 89%, 86%, 83%, and 81%. Only nine (6.7%) patients had outcome classes III or IV at any point during follow-up. Of the patients tested, 26% of those operated on the left side and 22% of those operated on the right had postoperative decline of >1 SD in verbal or visual memory, respectively.


CONCLUSIONS
High rates of seizure freedom can be obtained and remain stable over the years in patients operated on for unilateral MTLE/HS, even in countries with limited resources.
Paglioli
Eliseu
E
Porto Alegre Epilepsy Surgery Program, Hospital São Lucas da Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS, Brazil. epaglioli@hotmail.com
Palmini
André
A
Paglioli
Eduardo
E
da Costa
Jaderson C
JC
Portuguez
Mirna
M
Martinez
José V
JV
Calcagnotto
Maria E
ME
Hoefel
João R
JR
Raupp
Sergio
S
Barbosa-Coutinho
Ligia
L
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011877:Radionuclide Imaging; D012598:Sclerosis; D016019:Survival Analysis; D016896:Treatment Outcome