title: Factors predicting seizure outcome of anterior temporal lobectomy for patients with mesial temporal sclerosis.
abstract: OBJECTIVE
  To investigate the factors, including those associated with ictal scalp EEG results, related to surgical outcome in patients with pathologically proven mesial temporal sclerosis.
  
  
  METHODS
  We studied 51 consecutive patients who underwent anterior temporal lobectomy and had at least 4 years of follow-up. Surgical outcome was classified as being seizure-free or not seizure-free during the first two and the subsequent two postoperative years. Clinical variables and scalp EEG parameters were subjected to statistical analysis.
  
  
  RESULTS
  Of the 51 patients, 36 (70.6%) were seizure-free during postoperative years 3 and 4. Logistic regression analysis revealed that seizure remission for the first 2 years (p = 0.002) and contralateral propagated ictal discharges (p = 0.015) were independently related to seizure outcome at 4 years. Patients who were seizure-free at 2 years had an 86.5% chance of remaining seizure-free at 4 years. Of the patients without bitemporal asynchrony or switch of lateralization, 88.9% were seizure free at 4 years, compared with 54.5% of patients with asynchrony or switch of lateralization (p = 0.007). These two factors, however, were not predictive of seizure outcome at 2 years.
  
  
  CONCLUSIONS
  Contralateral propagated ictal discharges, including bitemporal asynchrony and switch of lateralization, unfavorably influence long-term seizure outcome. Long-term seizure control is best when the patient has no such propagation patterns of ictal discharges and is seizure-free during the first 2 years after temporal lobectomy.
authors.affiliation: Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. salee@amc.seoul.kr
authors.forename: Sang-Ahm
authors.initials: SA
authors.lastname: Lee
authors.forename: Soo Bin
authors.initials: SB
authors.lastname: Yim
authors.forename: Young Min
authors.initials: YM
authors.lastname: Lim
authors.forename: Joong Koo
authors.initials: JK
authors.lastname: Kang
authors.forename: Jung Kyo
authors.initials: JK
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D038481:Anterior Temporal Lobectomy; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012074:Remission Induction; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology*; D016896:Treatment Outcome