Predictors of outcome after temporal lobectomy for refractory temporal lobe epilepsy.
OBJECTIVE
To identify predictors of outcome after epilepsy surgery in patients with temporal lobe epilepsy (TLE).


METHODS
Seventy-six patients with normal magnetic resonance imaging (MRI) or hippocampal sclerosis on MRI who underwent anterior temporal lobe resections were included. Outcome 2 years after surgery was classified as good (Engel I and II) or poor (Engel III and IV). Gender, age at onset and duration of epilepsy, history of febrile convulsions, auras, right- or left-sided TLE, memory ipsilateral to seizure onset (Wada test), hippocampal asymmetry (HA) and T2 relaxation time, amygdala, temporal lobe and hemispheral volume were tested for associations with outcome.


RESULTS
Sixty-seven percent had a good outcome. Of all parameters tested, only a history of febrile convulsions and HA on quantitative MRI were significantly associated with a good seizure outcome. The absence of these parameters did not exclude a good outcome, but only five of 18 patients (28%) without HA and without a history of febrile convulsions had a good outcome.


CONCLUSIONS
Febrile convulsions and HA were predictors of outcome after epilepsy surgery in TLE. Subtle volume loss in amygdala, temporal lobe or hemispheres and the memory ipsilateral to the side of resection were not associated with outcome.
Wieshmann
U C
UC
The Walton Centre for Neurology and Neurosurgery, Liverpool, UK. udo.wieshmann@thewaltoncentre.nhs.uk
Larkin
D
D
Varma
T
T
Eldridge
P
P
D000328:Adult; D017668:Age of Onset; D001284:Atrophy / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005911:Gliosis / Q000209:etiology / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D019635:Neurosurgical Procedures; D018579:Patient Selection; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D003294:Seizures, Febrile / Q000453:epidemiology; D012737:Sex Factors; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome