title: An 18-year follow-up of seizure outcome after surgery for temporal lobe epilepsy and hippocampal sclerosis.
abstract: OBJECTIVE
  To evaluate the very long-term clinical outcome of surgery for mesial temporal lobe epilepsy and unilateral hippocampal sclerosis (MTLE/HS) without atypical features. The impact of surgical technique and postoperative reduction of medication on this outcome was investigated.
  
  
  METHODS
  Prospective longitudinal cohort follow-up study for up to18 years.
  
  
  METHODS
  Epilepsy surgery centre in a university hospital.
  
  
  METHODS
  108 patients who underwent unilateral MTLE/HS.
  
  
  METHODS
  Surgery for MTLE/HS.
  
  
  METHODS
  Engel classification (I). Clinical evaluations were based on systematic interviews in person or by phone. Kaplan-Maier survival curves estimated the probability of remaining seizure free. The impact of medication management in the postoperative outcome was analysed using Cox regression.
  
  
  RESULTS
  The probability of remaining completely seizure-free at 12 and 18 years after MTLE/HS surgery was 65% and 62%, respectively. The risk of having any recurrence was 22% during the first 24 months and increased 1.4% per year afterwards. Type of surgical technique (selective amygdalohippocampectomy vs anterior temporal lobectomy) did not impact on outcome. Remaining on antiepileptic drugs and history of generalised clonic seizure diminished the probability of remaining seizure free.
  
  
  CONCLUSIONS
  MTLE/HS surgery is able to keep patients seizure free for almost up to two decades. Removal of the neocortex besides the mesial portion of the temporal lobe does not lead to better chances of seizure control. These findings are applicable to the typical unilateral MTLE/HS syndrome and cannot be generalised for all types of TLE. Future longitudinal randomised controlled studies are needed to replicate these findings.
authors: Serviço de Neurologia, Hospital São Lucas da PUCRS. Av. Ipiranga, 6690 #220 90610-000, Porto Alegre, RS, Brazil; apalmini@uol.com.br.
authors: Marta
authors: M
authors: Hemb
authors: Andre
authors: A
authors: Palmini
authors: Eliseu
authors: E
authors: Paglioli
authors: Eduardo Beck
authors: EB
authors: Paglioli
authors: Jaderson
authors: J
authors: Costa da Costa
authors: Ney
authors: N
authors: Azambuja
authors: Mirna
authors: M
authors: Portuguez
authors: Verena
authors: V
authors: Viuniski
authors: Linda
authors: L
authors: Booij
authors: Magda Lahorgue
authors: ML
authors: Nunes
mesh_terms: D000293:Adolescent; D000328:Adult; D000679:Amygdala / Q000601:surgery; D038481:Anterior Temporal Lobectomy; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D004351:Drug Resistance; D004567:Electrodes, Implanted; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000453:epidemiology; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019579:Neocortex / Q000601:surgery; D019635:Neurosurgical Procedures; D012044:Regression Analysis; D012598:Sclerosis; D012640:Seizures / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Anticonvulsants; EEG; Epilepsy; Epilepsy, Surgery