Predictive factors for postoperative outcome in temporal lobe epilepsy according to two different classifications.
OBJECTIVE
The determination of prognostic factors is important for predicting outcome after epilepsy surgery. We investigated the factors related to surgical outcome within a homogeneous group of patients suffering from pathologically proven mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS), and compared Engel's outcome classification system with the latest one proposed by the ILAE.


METHODS
We included 109 patients with MTLE-HS who were followed-up for at least 1 year after epilepsy surgery. A retrospective chart review was performed to extract patients' demographic details, and potential pre-postoperative risk factors. Outcome of surgery was defined by the Engel's and ILAE classifications. In addition, the course of prognosis was determined according to the changes in ILAE classifications on an annual basis. Univariate and multivariate logistic regression analyses were used for the latest available outcomes and two different courses of prognosis.


RESULTS
The average duration of follow up was 4.78+/-2.55 years in the 109 patients with MTLE-HS. The univariate and multiple logistic regression analyses showed that the occurrence of seizures during the first month after surgery was a significant risk factor for a poor outcome. A history of trauma was also significant for patients with late recurrence of postsurgical seizures after at least 1-year seizure remission.


CONCLUSIONS
The occurrence of seizures during the first month after surgery is a significant prognostic factor in patients with MTLE-HS. Ignoring early postoperative seizures in classification systems may result in difficulty in identifying the course of epilepsy after surgery.
Tezer
F Irsel
FI
Institute of Neurological Sciences and Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey. irseltezer@yahoo.com.tr
Akalan
Nejat
N
Oguz
Kader K
KK
Karabulut
Erdem
E
Dericioglu
Nese
N
Ciger
Abdurrahman
A
Saygi
Serap
S
D000328:Adult; D000704:Analysis of Variance; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care / Q000145:classification* / Q000379:methods*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies