Prognostic factors for the surgery for mesial temporal lobe epilepsy: longitudinal analysis.
OBJECTIVE
Determining long-term prognostic factors of surgery for mesial temporal lobe epilepsy (MTLE) is important for identifying ideal candidates and predicting the prognosis for individual patients. We tried to identify the prognostic factors of anterior temporal lobectomy (ATL) for MTLE with longitudinal multivariate analysis.


METHODS
Two hundred twenty-seven patients with MTLE were included in this study. The primary outcome variable was patient status 1-5 years after surgery: seizure free, or not. Clinical characteristics and recent diagnostic modalities were considered as prognostic factors. Univariate and standard multiple logistic-regression analysis for outcome at 1 and 5 years after surgery and the generalized estimation equation (GEE) model for longitudinal multiple logistic regression of the 5-year follow-up period were used.


RESULTS
The seizure-free rate at 1 year was 81.1% and decreased to 75.2% at 5 years after surgery. By the univariate or standard multiple logistic-regression analysis, age at surgery or hippocampal sclerosis on magnetic resonance imaging (MRI) ipsilateral to surgery was significant for the postsurgical outcome. However, the longitudinal analysis by the GEE model revealed that younger age at surgery [odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43-0.81], absence of secondarily generalized tonic-clonic seizure (2 degrees GTCS; OR, 0.45; 95% CI, 0.26-0.79), and hippocampal sclerosis on MRI (OR, 2.44; 95% CI, 1.11-5.26) were significant predictors of a good surgical outcome.


CONCLUSIONS
Age at surgery, presence of 2 degrees GTCS, and hippocampal sclerosis on MRI are independent prognostic factors for ATL in MTLE. These findings suggest that MTLE is a progressive disorder, and surgical outcome is better when early ATL is performed.
Jeong
Sang-Wuk
SW
Department of Neurology and Clinical Research Institute, Ilsan Paik Hospital, Inje University, Goyang City, Korea.
Lee
Sang Kun
SK
Hong
Keun-Sik
KS
Kim
Kwang-Ki
KK
Chung
Chun-Kee
CK
Kim
Ho
H
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D038481:Anterior Temporal Lobectomy; D001284:Atrophy; D002648:Child; D018572:Disease-Free Survival; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000601:surgery*; D004830:Epilepsy, Tonic-Clonic / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011300:Preoperative Care; D011379:Prognosis; D012598:Sclerosis / Q000473:pathology; D016896:Treatment Outcome