Clinical features of patients with posterior cortex epilepsies and predictors of surgical outcome.
OBJECTIVE
Posterior cortex epilepsies (PCEs) encompass a group of epilepsies originating from the occipital, parietal, or occipital border of the temporal lobe, or from any combination of these regions. When their seizures are refractory to pharmacologic treatment, these patients are usually referred for surgery. The aim of our study was to analyze clinical characteristics of all PCE patients referred for surgery from 1994 to 2003, and to search for predictors of surgical outcome.


METHODS
We performed a retrospective analysis of clinical and laboratory data from 81 consecutive refractory PCE patients referred for surgery. Surgical and nonsurgical groups of patients were compared, and detailed analyses of all variables of the surgical cases were performed in the search for predictors of seizure outcome.


RESULTS
Risk factors for PCEs included gliosis (34.56%), malformations of cortical development (33.33%), tumors (8.64%), brain trauma (3.70%), Sturge-Weber disease (4.93%), vascular malformations (3.70%), family history of epilepsy (3.70%), history of CNS infections (2.46%), and low IQ (2.46%). Of the 81 patients, 44 were submitted to surgery at the time of the completion of this study. Surgical treatment was highly effective in improving seizures (p<0.001) when compared with previous pharmacologic treatment alone. Twenty-eight (65.11%) patients became seizure free after surgery versus none in the nonsurgical group. Regarding outcome predictors, patients with shorter duration of epilepsy and those without neurologic abnormalities on clinical examination had higher chances of favorable evolution.


CONCLUSIONS
Surgical treatment is effective for the treatment of PCEs and superior to pharmacologic therapy alone. In our series, shorter duration of epilepsy and normal neurologic examination were the only independent variables that predicted better surgical outcome.
Dalmagro
Charles L
CL
Epilepsy Surgery Center, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo Ribeirão Preto, Brazil.
Bianchin
Marino M
MM
Velasco
Tonicarlo R
TR
Alexandre
Veriano
V
Walz
Roger
R
Terra-Bustamante
Vera C
VC
Inuzuka
Luciana M
LM
Wichert-Ana
Lauro
L
Araújo
David
D
Serafini
Luciano N
LN
Carlotti
Carlos G
CG
Assirati
João A
JA
Machado
Hélio R
HR
Santos
Antonio C
AC
Sakamoto
Américo C
AC
D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology* / Q000601:surgery; D004569:Electroencephalography / Q000706:statistics & numerical data; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010296:Parietal Lobe / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D014743:Videotape Recording