title: Long-term outcome after temporal lobe surgery--prediction of late worsening of seizure control.
abstract: We analyzed possible predictors of late worsening of seizure control in 94 adult patients who had anterior temporal lobectomy (ATL) from the Epilepsy Center of the National Institute of Psychiatry and Neurology, Budapest between 1985 and 2001. We evaluated data regarding epilepsy, presurgical evaluation, pre- and postoperative EEG, structural imaging, histology and operative complications. The mean follow-up was 6.1 years (range: 2-17 years). The outcome was measured as Engel class, the time to the first seizure and the longest seizure free period. Multiple regression analysis was used to assess predictors. Seizure free outcome was achieved in 72% of the patients 1-year after surgery. Eighty-seven percent of them remained seizure free at the second year of follow-up, 74% at the fifth, and 67% at the tenth year of follow-up. After 2 years of follow-up improvement was present in 3%, worsening in 18% of the patients. Factors associated with long-term worsening were: postoperative ipsilateral EEG spikes over the resected side, preoperative bilateral interictal discharges, cortical dysplasia of Taylor's type, and ictal contralateral propagation. In these patients, even in seizure free state, therapy reduction might be inappropriate.
authors.affiliation: National Institute of Psychiatry and Neurology, Budapest, Huvösvölgyi út 116, Hungary. kelemen@opni.hu
authors.forename: Anna
authors.initials: A
authors.lastname: Kelemen
authors.forename: Péter
authors.initials: P
authors.lastname: Barsi
authors.forename: Lóránd
authors.initials: L
authors.lastname: Eross
authors.forename: János
authors.initials: J
authors.lastname: Vajda
authors.forename: Sándor
authors.initials: S
authors.lastname: Czirják
authors.forename: Csaba
authors.initials: C
authors.lastname: Borbély
authors.forename: György
authors.initials: G
authors.lastname: Rásonyi
authors.forename: Péter
authors.initials: P
authors.lastname: Halász
mesh_terms: D000293:Adolescent; D000328:Adult; D038481:Anterior Temporal Lobectomy; D004833:Epilepsy, Temporal Lobe / Q000145:classification / Q000517:prevention & control / Q000601:surgery*; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012307:Risk Factors; D055502:Secondary Prevention; D012640:Seizures / Q000517:prevention & control* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome