Long-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients.
OBJECTIVE
The aim of this study was to evaluate the long-term efficacy of temporal lobe epilepsy (TLE) surgery and potential risk factors for seizure recurrence after surgery.


METHODS
This retrospective study included 434 consecutive adult patients who underwent TLE surgery at Bethel Epilepsy Centre between 1991 and 2002.


RESULTS
Hippocampal sclerosis was found in 62% of patients, gliosis in 17.3%, tumors in 20%, and focal cortical dysplasia (FCD) in 6.9%. Based on a Kaplan-Meier analysis, the probability of Engel Class I outcome for the patients overall was 76.2% (95% CI 71-81%) at 6 months, 72.3% (95% CI 68-76%) at 2 years, 71.1% (95% CI 67-75%) at 5 years, 70.8% (95% CI 65-75%) at 10 years, and 69.4% (95% CI 64-74%) at 16 years postoperatively. The likelihood of remaining seizure free after 2 years of freedom from seizures was 90% (95% CI 82-98%) for 16 years. Seizure relapse occurred in all subgroups. Patients with FCD had the highest risk of recurrence (hazard ratio 2.15, 95% CI 0.849-5.545). Predictors of remission were the presence of hippocampal atrophy on preoperative MR imaging and a family history of epilepsy. Predictors of relapse were the presence of bilateral interictal sharp waves and versive seizures. Six-month follow-up electroencephalography predicted relapse in patients with FCD. Short epilepsy duration was predictive of seizure remission in patients with tumors and gliosis; 28.1% of patients were able to discontinue antiepileptic medications without an increased risk of seizure recurrence (hazard ratio 1.05, 95% CI 0.933-1.20).


CONCLUSIONS
These findings highlight the role of etiology in prediction of long-term outcome after TLE surgery.
Elsharkawy
Alaa Eldin
AE
Department of Presurgical Evaluation, Bethel Epilepsy Centre, Bielefeld, Germany.
Alabbasi
Abdel Hamid
AH
Pannek
Heinz
H
Oppel
Falk
F
Schulz
Reinhard
R
Hoppe
Mathias
M
Hamad
Ana Paula
AP
Nayel
Mohamed
M
Issa
Ahmed
A
Ebner
Alois
A
D000293:Adolescent; D000328:Adult; D038481:Anterior Temporal Lobectomy; D018572:Disease-Free Survival; D004833:Epilepsy, Temporal Lobe / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012598:Sclerosis; D016896:Treatment Outcome; D055815:Young Adult