Failed surgery for temporal lobe epilepsy: predictors of long-term seizure-free course.
OBJECTIVE
To identify prognostic factors which predict the outcome 2 years after TLE surgery in those patients who were not seizure-free at the 6-month postoperative examination.


METHODS
We included 86 postoperative TLE patients who had undergone presurgical evaluation, including video-EEG and high-resolution MRI, and who had seizures between the second and sixth postoperative months.


RESULTS
32% of patients were seizure-free in the second postoperative year. We found that normal MRI findings and secondarily generalized seizures (SGTCS) preoperatively were associated with a non-seizure-free outcome, while rare postoperative seizures and ipsilateral temporal IED with seizure-free outcome. Newly administered levetiracetam showed a significant positive effect on the postoperative outcome independent of other prognostic factors. Five of seven patients who received levetiracetam became seizure-free (p = 0.006).


CONCLUSIONS
One-third of patients who did not become seizure-free immediately after surgery, eventually achieved long-term seizure freedom. We suggest watching for long-term seizure freedom after failed epilepsy surgery especially in patients who had rare postoperative seizures, focal MRI abnormality, ipsilateral temporal spikes, or no SGTCS preoperatively. Levetiracetam may have a positive effect on postsurgical seizures.
Janszky
J
J
Epilepsy Centre Bethel, Klinik Mara 1, Maraweg 21, Bielefeld 33617, Germany. janszky@index.hu
Pannek
H W
HW
Janszky
I
I
Schulz
R
R
Behne
F
F
Hoppe
M
M
Ebner
A
A
D000328:Adult; D038481:Anterior Temporal Lobectomy; D000927:Anticonvulsants / Q000627:therapeutic use; D004569:Electroencephalography / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009460:Neurologic Examination; D011184:Postoperative Period; D012372:ROC Curve; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
D000927:Anticonvulsants