Latency to first seizure after temporal lobectomy predicts  long-term outcome.
OBJECTIVE
Temporal lobectomy is a well-established treatment for refractory temporal lobe epilepsy, yet many patients experience at least one seizure postoperatively. Little is known about the prognostic significance of the time from surgery to first seizure relapse in predicting long-term outcome.


METHODS
In a retrospective analysis of patients who reported at least one complex partial seizure (CPS) or generalized tonic–clonic seizure (GTCS) after anterior temporal lobectomy (n = 268), we used a nominal response logistic model to predict the odds ratio (OR) of a seizure outcome based on length of the latency period from surgery to first postoperative seizure. A modified Engel outcome class scheme was used. We controlled for factors known to influence postoperative outcome, including history of tonic–clonic seizures, intelligence quotient (IQ), preoperative seizure frequency, magnetic resonance imaging (MRI) findings, and history of febrile convulsions.


RESULTS
In the univariate analysis, the latency from surgery to the first postoperative disabling seizure was significantly associated with long-term outcome. Longer latency was associated with higher odds of being seizure-free or improved (modified Engel's classes 1, 2, and 3) relative to the unimproved state (class 4) (p < 0.001, 0.001 and 0.004, respectively). Conversely, a shorter latency increased the likelihood of achieving the worst prognosis (class 4) relative to class 1 (p < 0.001). Multivariate analysis yielded similar results.


CONCLUSIONS
Latency to the first postoperative seizure predicts long-term outcome, with short latencies portending poor prognosis and long latencies portending a good prognosis. This information can be used for patient counseling and may influence decisions regarding reoperation.
Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Sarah E
SE
Buckingham
Inna
I
Chervoneva
Ashwini
A
Sharan
Andro
A
Zangaladze
Scott
S
Mintzer
Christopher
C
Skidmore
Maromi
M
Nei
James
J
Evans
Edward
E
Pequignot
Michael R
MR
Sperling
D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D018572:Disease-Free Survival; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012107:Research Design; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome