Long-term prognosis and psychosocial outcomes after surgery for MTLE.
OBJECTIVE
To assess the seizure-freedom rates and self-perceived psychosocial changes associated with the long-term outcome of epilepsy surgery in patients with refractory medial temporal lobe epilepsy associated with hippocampal sclerosis.


METHODS
A standard questionnaire was given to 183 patients who underwent surgery between 1988 and 2004, and 110 were completed.


RESULTS
The mean duration of follow-up after surgery was 7 years, with a maximum of 17 years. The probability that patients were seizure-free after surgery was dependent on the definition of the seizure freedom. For the patients who were seizure-free since surgery (Engel's class Ia), the probability was 97.6% at 1 year after surgery, 85.2% at 2 years after surgery, 59.5% at 5 years after surgery, and 42.6% at 10 years after surgery. For the patients who still experienced rare disabling seizures after surgery but were seizure-free at least 1 year before the time of assessment, the probability was of 97.6% at 1 year after surgery, 95% at 2 years after surgery, 82.8% at 5 years after surgery, and 71.1% at 10 years after surgery. The psychosocial long-term outcome, as measured by indices of driving, employment, familial and social relationships, and marital status, was similar to the psychosocial short-term outcome. It did not depend on seizure freedom or on follow-up time interval and was not influenced statistically by seizure frequency in cases of persisting seizures. Most but not all patients noticed a substantial overall improvement in their psychosocial condition; 48% drove (increased by 7%), 47% improved (14% worsened) in their employment status, and 68% improved (5% worsened) in their familial and social relationships. Overall, 91% of patients were satisfied with the surgery, and 92% did not regret their decision.


CONCLUSIONS
The results of this study suggest that temporal lobe surgery has real long-term benefits. Two specific conclusions emerge: (a) the long-term rates of freedom from seizure depend on how seizure freedom is defined, and (b) the psychosocial long-term outcome does not change dramatically over years and does not depend on seizure freedom.
Dupont
Sophie
S
Unité d'Epileptologie, Clinique Neurologique Paul Castaigne, Paris, France. sophie.dupont@psl.ap-hop-paris.fr
Tanguy
Marie-Laure
ML
Clemenceau
Stephane
S
Adam
Claude
C
Hazemann
Paule
P
Baulac
Michel
M
D000223:Adaptation, Psychological; D000328:Adult; D000679:Amygdala / Q000601:surgery; D038481:Anterior Temporal Lobectomy; D000927:Anticonvulsants / Q000627:therapeutic use; D018572:Disease-Free Survival; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006624:Hippocampus / Q000473:pathology / Q000601:surgery; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017060:Patient Satisfaction; D011379:Prognosis; D012008:Recurrence; D012917:Social Adjustment; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome
D000927:Anticonvulsants