title: Long-term outcome of extratemporal epilepsy surgery among 154 adult patients.
abstract: OBJECTIVE
  The goal of this study was to evaluate the long-term outcome of patients who underwent extratemporal epilepsy surgery and to assess preoperative prognostic factors associated with seizure outcome.
  
  
  METHODS
  This retrospective study included 154 consecutive adult patients who underwent epilepsy surgery at Bethel Epilepsy Centre, Bielefeld, Germany between 1991 and 2001. Seizure outcome was categorized based on the modified Engel classification. Survival statistics were calculated using Kaplan-Meier curves, life tables, and Cox regression models to evaluate the risk factors associated with outcomes.
  
  
  RESULTS
  Sixty-one patients (39.6%) underwent frontal resections, 68 (44.1%) had posterior cortex resections, 15 (9.7%) multilobar resections, 6 (3.9%) parietal resections, and 4 (2.6%) occipital resections. The probability of an Engel Class I outcome for the overall patient group was 55.8% (95% confidence interval [CI] 52-58% at 0.5 years), 54.5% (95% CI 50-58%) at 1 year, and 51.1% (95% CI 48-54%) at 14 years. If a patient was in Class I at 2 years postoperatively, the probability of remaining in Class I for 14 years postoperatively was 88% (95% CI 78-98%). Factors predictive of poor long-term outcome after surgery were previous surgery (p = 0.04), tonic-clonic seizures (p = 0.02), and the presence of an auditory aura (p = 0.03). Factors predictive of good long-term outcome were surgery within 5 years after onset (p = 0.015) and preoperative invasive monitoring (p = 0.002).
  
  
  CONCLUSIONS
  Extratemporal epilepsy surgery is effective according to findings on long-term follow-up. The outcome at the first 2-year follow-up visit is a reliable predictor of long-term Engel Class I postoperative outcome.
authors: Department of Presurgical Evaluation, Bethel Epilepsy Centre, Bielefeld, Germany.
authors: Alaa Eldin
authors: AE
authors: Elsharkawy
authors: Friedrich
authors: F
authors: Behne
authors: Falk
authors: F
authors: Oppel
authors: Heinz
authors: H
authors: Pannek
authors: Reinhard
authors: R
authors: Schulz
authors: Mathias
authors: M
authors: Hoppe
authors: Gerald
authors: G
authors: Pahs
authors: Csilla
authors: C
authors: Gyimesi
authors: Mohamed
authors: M
authors: Nayel
authors: Ahmed
authors: A
authors: Issa
authors: Alois
authors: A
authors: Ebner
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology / Q000601:surgery*; D004827:Epilepsy / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000517:prevention & control; D016896:Treatment Outcome