Prognostic factors in neocortical epilepsy surgery: multivariate analysis.
OBJECTIVE
Defining prognostic factors for neocortical epilepsy surgery is important for the identification of ideal candidates and for predicting the prognosis of individual patients. We use multivariate analysis to identify favorable prognostic factors for neocortical epilepsy surgery.


METHODS
One hundred ninety-three neocortical epilepsy patients, including 91 without focal lesions on MRI, were included. Sixty-one had frontal lobe epilepsy (FLE), 80 had neocortical temporal lobe epilepsy (nTLE), 21 had parietal lobe epilepsy (PLE), and 22 had occipital lobe epilepsy (OLE). The primary outcome variable was patient status >or=2 years after surgery (i.e., seizure free or not). Clinical characteristics and the recent presurgical diagnostic modalities were considered as probable prognostic factors. Univariate and standard multiple logistic regression analyses were used to identify favorable prognostic factors.


RESULTS
The seizure-free rate was 57.5%. By univariate analysis, a focal lesion on MRI, localized ictal onset on surface EEG, epilepsies other than FLE, localized hypometabolism on fluorodeoxyglucose-positron emission tomography (FDG-PET), and pathologies other than cortical dysplasia were significantly associated with a seizure-free outcome (p<0.05). Multivariate analysis revealed that a focal lesion on MRI (p=0.003), correct localization by FDG-PET (p=0.007), and localized ictal onset on EEG (p=0.01) were independent predictors of a good outcome.


CONCLUSIONS
The presence of a focal lesion on MRI, correct localized hypometabolism on FDG-PET, or localized ictal rhythms on EEG were identified as predictors of a seizure-free outcome. Our results suggest that these findings allow the selection of better candidates for neocortical epilepsy surgery.
Yun
Chang-Ho
CH
Department of Neurology, Inha University College of Medicine, Incheon, South Korea.
Lee
Sang Kun
SK
Lee
Seo Young
SY
Kim
Kwang Ki
KK
Jeong
Sang Wook
SW
Chung
Chun-Ki
CK
D000328:Adult; D018572:Disease-Free Survival; D004569:Electroencephalography / Q000706:statistics & numerical data; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D019579:Neocortex / Q000503:physiopathology*; D009778:Occipital Lobe / Q000503:physiopathology / Q000601:surgery; D010296:Parietal Lobe / Q000503:physiopathology / Q000601:surgery; D018579:Patient Selection; D049268:Positron-Emission Tomography; D011379:Prognosis; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18