title: Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome.
abstract: Temporal lobe epilepsy (TLE) accompanied by hippocampal sclerosis (HS) is the type of epilepsy most frequently operated on. The predictors for long-term seizure freedom after surgery of TLE-HS are unknown. In this study, we aimed to identify prognostic factors which predict the outcome 6 months and 2, 3 and 5 years after epilepsy surgery of TLE-HS. Our working hypothesis was that the prognostic value of potential predictors depended on the post-operative time interval for which the assessment was made. We included 171 patients (100 females and 71 males, aged 16-59 years) who had undergone presurgical evaluation, including video-EEG, who had had MRI-defined HS, and who had undergone temporal lobectomy. We found that secondarily generalized seizures (SGTCS) and ictal dystonia were associated with a worse 2-year outcome. Both these variables together with older age and longer epilepsy duration were also related to a worse 3-year outcome. Ictal limb dystonia, older age and longer epilepsy duration were associated with long-term surgical failure evaluated 5 years post-operatively. In order to determine the independent predictors of outcomes, we calculated multivariate analyses. The presence of SGTCS and ictal dystonia independently predicted the 2-year outcome. Longer epilepsy duration and ictal dystonia predicted the 3-year outcome. Longer epilepsy duration (P = 0.003) predicted a poor 5-year outcome. Conclusively, predictors for the long-term surgical results of TLE with HS are different from those variables that predict the short-term outcome. Epilepsy duration is the most important predictor for long-term surgical outcome. Our results strongly suggest that surgery for TLE-HS should be performed as early as possible.
authors.affiliation: National Institute of Psychiatry and Neurology, Semmelweis University, Budapest, Hungary. janszky@index.hu
authors.forename: J
authors.initials: J
authors.lastname: Janszky
authors.forename: I
authors.initials: I
authors.lastname: Janszky
authors.forename: R
authors.initials: R
authors.lastname: Schulz
authors.forename: M
authors.initials: M
authors.lastname: Hoppe
authors.forename: F
authors.initials: F
authors.lastname: Behne
authors.forename: H W
authors.initials: HW
authors.lastname: Pannek
authors.forename: A
authors.initials: A
authors.lastname: Ebner
mesh_terms: D000293:Adolescent; D000328:Adult; D038481:Anterior Temporal Lobectomy; D004812:Epidemiologic Methods; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012598:Sclerosis; D013997:Time Factors; D016896:Treatment Outcome