title: Acute postoperative seizures and long-term seizure outcome after surgery for hippocampal sclerosis.
abstract: OBJECTIVE
  To assess the incidence and the prognostic value of acute postoperative seizures (APOS) in patients surgically treated for drug-resistant temporal lobe epilepsy due to hippocampal sclerosis (TLE-HS).
  
  
  METHODS
  We studied 139 consecutive patients with TLE-HS who underwent epilepsy surgery and were followed up for at least 5 years (mean duration of follow-up 9.1 years, range 5-15). Medical charts were reviewed to identify APOS, defined as ictal events with the exception of auras occurring within the first 7 days after surgery. Seizure outcome was determined at annual intervals. Patients who were in Engel Class Ia at the last contact were classified as having a favorable outcome.
  
  
  RESULTS
  Seizure outcome was favorable in 99 patients (71%). Six patients (4%) experienced APOS and in all cases their clinical manifestations were similar to the habitual preoperative seizures. All patients with APOS had unfavorable long-term outcome, as compared with 35 (26%) of 133 in whom APOS did not occur (p<0.001).
  
  
  CONCLUSIONS
  Our study suggests that APOS, despite being relatively uncommon in patients undergoing resective surgery for TLE-HS, are associated with a worse long-term seizure outcome. Given some study limitations, our findings should be regarded as preliminary and need confirmation from future larger, prospective, multicenter studies.
authors.affiliation: IRCCS "NEUROMED", Pozzilli, IS, Italy. Electronic address: gdigennaro@neuromed.it.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Di Gennaro
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Casciato
authors.affiliation: IRCCS "NEUROMED", Pozzilli, IS, Italy.
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Quarato
authors.affiliation: IRCCS "NEUROMED", Pozzilli, IS, Italy.
authors.forename: Addolorata
authors.initials: A
authors.lastname: Mascia
authors.affiliation: IRCCS "NEUROMED", Pozzilli, IS, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: D'Aniello
authors.affiliation: IRCCS "NEUROMED", Pozzilli, IS, Italy.
authors.forename: Liliana G
authors.initials: LG
authors.lastname: Grammaldo
authors.affiliation: IRCCS "NEUROMED", Pozzilli, IS, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: De Risi
authors.affiliation: IRCCS "NEUROMED", Pozzilli, IS, Italy; Neurone' Foundation for Research in Neuropsychobiology and Clinical Neurosciences, Rome, Italy.
authors.forename: Giulio N
authors.initials: GN
authors.lastname: Meldolesi
authors.affiliation: IRCCS "NEUROMED", Pozzilli, IS, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Romigi
authors.affiliation: IRCCS "NEUROMED", Pozzilli, IS, Italy; Department of Neurosurgery, Sapienza University of Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Esposito
authors.affiliation: Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Picardi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004833:Epilepsy, Temporal Lobe / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology*; D012598:Sclerosis / Q000150:complications / Q000209:etiology; D012640:Seizures / Q000209:etiology*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute postoperative seizures; Epilepsy surgery; Hippocampal sclerosis; Outcome; Temporal lobe epilepsy