Seizure outcome 1 year after temporal lobe epilepsy: an analysis of MR volumetric and clinical parameters.
BACKGROUND
The aim of this work was to determine predictors that may contribute to surgical success or failure. Relevant pre- and postoperative baseline data were analyzed, and temporal structures underwent a volumetric analysis.


METHODS
A total of 207 patients (107 female) underwent complete evaluation for epilepsy surgery. Prospectively collected data used for this analysis included the clinical and demographic data. Classic prognostic factors (e.g., gender, age at operation, age at epilepsy manifestation, duration of epilepsy, education, side of pathology, intracranial EEG recordings, secondarily generalized tonic-clonic seizures, etiological factors, histology) and a volumetric analysis of 12 temporal lobe subregions were used in a regression analysis to identify possible prognostic factors in surgery for TLE. Primary outcome measure was seizure freedom at 1 year and during the full first year expressed as class I in the ILAE outcome scale.


RESULTS
In the univariate analysis, we identified one negative predictor for a less favorable seizure outcome: intracranial EEG recordings (p = 0.010), hippocampal sclerosis as histological finding trended toward statistical significance (p = 0.054). No statistical outcome significance was found for preoperative temporal lobe compartment volume loss or postoperative lateral atrophy after mesial resection.


CONCLUSIONS
Necessity for intracranial EEG recording is an independent factor of not optimal seizure control in the 1-year follow-up. Preoperative temporal lobe volume differences including smaller mesial subcompartments did not correlate with poorer seizure outcome.
Department of Neurosurgery, University of Bonn, Bonn, Germany. camueller@ukaachen.de
Christian-Andreas
CA
Mueller
Jasmin
J
Scorzin
Marec
M
von Lehe
Rolf
R
Fimmers
Christoph
C
Helmstaedter
Josef
J
Zentner
Thomas-Nicolas
TN
Lehmann
Heinz-Joachim
HJ
Meencke
Andreas
A
Schulze-Bonhage
Johannes
J
Schramm
D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy; D002648:Child; D004833:Epilepsy, Temporal Lobe / Q000473:pathology* / Q000601:surgery; D005260:Female; D006624:Hippocampus / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012598:Sclerosis / Q000473:pathology; D012640:Seizures / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult