Outcome of frontal lobe epilepsy surgery.
OBJECTIVE
There is still controversy in deciding which patients with frontal lobe epilepsy (FLE) should undergo resective surgery, even though it is a well-established therapy. The aim of this study is to define multiple outcome measures and determine whether there are certain subpopulations of preferred surgical candidates that have a more favorable seizure prognosis.


METHODS
Fifty-eight patients underwent resective FLE surgery with a mean follow-up period of 79.3 months (range 12-208 months). Patient demographics, clinical seizure characteristics, seizure-onset zone within the frontal lobes, and diagnostic tests were tabulated. Engel class, International League Against Epilepsy (ILAE) class, postoperative seizure patterns, time to first recurrent seizure, and seizures and employment during the last year of follow-up were used as outcome measures. Neuropsychological performance and Beck Depression Inventory (BDI) scores were used to define neuropsychological outcome and examined as predictors of seizure outcome.


RESULTS
Thirty-three (57%) patients with resective surgery had an Engel class I outcome and 29 (50%) had an ILAE class I outcome. Mean time to first seizure after surgery was 33.3 months (range 0-208). Only 14 patients (24%) were completely seizure-free without auras (Engel IA) throughout the entire follow-up period. The most common pattern of seizure recurrence was mixed, with prolonged periods of seizure freedom intermixed with recurrences. In addition, 32% of patients made gains in employment and 52% were able to reduce use of antiepileptic drugs (AEDs), although only 9% discontinued AEDs. No significant association was found between class I or class IA outcome and the presence of a focal magnetic resonance imaging (MRI) abnormality, any specific localization of seizure focus within the frontal lobe, or neuropsychological change.


CONCLUSIONS
Findings indicate that that long-term outcome is generally favorable in FLE resective surgery, and support the need for considering multiple outcome measures to more fully characterize clinically relevant postsurgical changes. Outcome can be favorable even in MRI-negative patients.
Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Stefanie P
SP
Lazow
Vijay M
VM
Thadani
Karen L
KL
Gilbert
Richard P
RP
Morse
Krzysztof A
KA
Bujarski
Kandan
K
Kulandaivel
Robert M
RM
Roth
Rodney C
RC
Scott
David W
DW
Roberts
Barbara C
BC
Jobst
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D004569:Electroencephalography; D004651:Employment; D017034:Epilepsy, Frontal Lobe / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000379:methods*; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000503:physiopathology*; D012640:Seizures / Q000175:diagnosis / Q000209:etiology; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation; D055815:Young Adult
D000927:Anticonvulsants