title: Predictors of spontaneous transient seizure remission in patients of medically refractory epilepsy due to mesial temporal sclerosis (MTS).
abstract: OBJECTIVE
  To analyze the predictors of spontaneous transient seizure remission for ≥1 year in patients with drug-resistant epilepsy (DRE) due to mesial temporal sclerosis (MTS).
  
  
  METHODS
  This analysis included 38 patients with DRE (M:F = 20:18, age: 31.7 ± 10.9 years) diagnosed with unilateral MTS (right:left = 16:22). Group I ('remission' group) comprised of patients with seizure remission (M:F = 10:8, age: 32.8 ± 12.3 years, mean seizure free period: 2.2 ± 1.1 years; median: 2.1 years). Group II ('non-remission' group) comprised of age and gender matched 20 patients (M:F = 10:10, age: 30.7 ± 9.7 years) with unilateral MTS who never had seizure remission and subsequently underwent epilepsy surgery. Groups I and II were compared to find the predictors associated with transient seizure remission.
  
  
  RESULTS
  The age at onset of seizures in group I was 13.2 ± 11.8 years and in group II was 12.0 ± 7.6 years. The duration of seizure was: group I - 19.7 ± 12.5 years and group II - 19.3 ± 7.7 years. Past history of seizure remissions (p < 0.001), frequent periods of remissions (p < 0.001), first remission within a year of onset of seizures (p = 0.04) and normal EEG (p = 0.04) were the important clinical predictors associated with seizure remission in this cohort. Fifteen patients in group I (83.3%) experienced remission following either change in AED (p ≤ 0.001) or increase in AED dosages (p < 0.001). There was no difference between the two groups regarding the type of semiology (partial vs. secondarily generalized) (p = 0.50), family history of seizures (p = 1.0), side of the lesion (p = 0.34), history of febrile seizures (p = 1.0) and the number of AEDs used (p = 0.53).
  
  
  CONCLUSIONS
  The present study unfolds, some of the clinically relevant predictors associated with transient seizure remission in patients with DRE and MTS. Future molecular and network studies are required to understand its mechanism.
authors.affiliation: Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Electronic address: drvikasdhiman.nimhans@gmail.com.
authors.forename: Vikas
authors.initials: V
authors.lastname: Dhiman
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Electronic address: sanjib_sinha2004@yahoo.co.in.
authors.forename: Sanjib
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Electronic address: arivazhagan.a@gmail.com.
authors.forename: Arivazhagan
authors.initials: A
authors.lastname: Arimappamagan
authors.affiliation: Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Electronic address: anita_mahadevan@yahoo.com.
authors.forename: Anita
authors.initials: A
authors.lastname: Mahadevan
authors.affiliation: Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Electronic address: drrosedawn@yahoo.com.
authors.forename: Rose Dawn
authors.initials: RD
authors.lastname: Bharath
authors.affiliation: Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Electronic address: jsaini76@gmail.com.
authors.forename: Jitender
authors.initials: J
authors.lastname: Saini
authors.affiliation: Department of Neuropsychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Electronic address: drjamunarajan@gmail.com.
authors.forename: Jamuna
authors.initials: J
authors.lastname: Rajeswaran
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Electronic address: brmalla@gmail.com.
authors.forename: Malla Bhaskar
authors.initials: MB
authors.lastname: Rao
authors.affiliation: Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Electronic address: shankarsk2004@gmail.com.
authors.forename: Susrala K
authors.initials: SK
authors.lastname: Shankar
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Electronic address: drpsatishchandra@yahoo.com.
authors.forename: Parathasarthy
authors.initials: P
authors.lastname: Satishchandra
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000503:physiopathology / Q000601:surgery; D015897:Comorbidity; D004351:Drug Resistance; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000150:complications; D011379:Prognosis; D012075:Remission, Spontaneous; D012598:Sclerosis; D012640:Seizures / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D013702:Temporal Lobe / Q000473:pathology
chemical_list: D000927:Anticonvulsants
keywords: Drug resistant epilepsy; Mesial temporal sclerosis; Seizure remission; TLE