title: Outcome of extratemporal epilepsy surgery experience of a single center.
abstract: OBJECTIVE
  Our aim was to determine the surgical outcome in adult patients with intractable extratemporal epilepsy and follow it over time.
  
  
  METHODS
  We retrospectively studied the operative outcome in 218 consecutive adult patients with extratemporal lesions who underwent resective surgical treatment for intractable partial epilepsy in the Bethel Epilepsy Center, Bielefeld, Germany, between 1991 and 2005. Patients were divided into three groups according to the 5-year period in which the surgical procedure took place.
  
  
  RESULTS
  Group I (1991-1995) consisted of 64 patients. The postoperative Engel Class I outcome was 50% at 6 months, 44.4% at 2 years, and 45.2% at 5 years. Group II (1996-2000) included 91 patients. Engel Class I outcome was 57.1% at 6 months, 53.8% at 2 years, and 53.5% at 5 years. In Group III (2001-2005), there were 63 patients. Engel Class I outcome was 65.1% at 6 months, 61.3% at 2 years, and 60.6% at 5 years. Short duration of epilepsy, surgery before 30 years of age, pathological findings of neoplasm, and well-circumscribed lesions on the preoperative magnetic resonance imaging scan were good prognostic factors. Poor prognostic factors were one or more of the following: psychic aura, generalized tonic-clonic seizure, versive seizure, history of previous surgery, and focal cortical dysplasia. On multivariate analysis, only the presence of well-circumscribed lesions on preoperative magnetic resonance imaging predicted a positive outcome (P = 0.001).
  
  
  CONCLUSIONS
  Our results indicate that extratemporal epilepsy surgery at the Bethel Epilepsy Center has become more effective in the treatment of extratemporal epilepsy patients over the years, ensuring continuous improvement in outcome. This improvement can be attributed mainly to more restrictive patient selection.
authors.affiliation: Department of Presurgical Evaluation, Bethel Epilepsy Center, Bielefeld, Germany. alois.ebner@evkb.de
authors.forename: Alaa E
authors.initials: AE
authors.lastname: Elsharkawy
authors.forename: Heinz
authors.initials: H
authors.lastname: Pannek
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schulz
authors.forename: Mathias
authors.initials: M
authors.lastname: Hoppe
authors.forename: Gerald
authors.initials: G
authors.lastname: Pahs
authors.forename: Csilla
authors.initials: C
authors.lastname: Gyimesi
authors.forename: Mohamed
authors.initials: M
authors.lastname: Nayel
authors.forename: Ahmed
authors.initials: A
authors.lastname: Issa
authors.forename: Alois
authors.initials: A
authors.lastname: Ebner
mesh_terms: D000046:Academic Medical Centers / Q000639:trends; D000293:Adolescent; D000328:Adult; D000368:Aged; D004828:Epilepsies, Partial / Q000503:physiopathology / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000639:trends*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult