title: Surgery for "Long-term epilepsy associated tumors (LEATs)": Seizure outcome and its predictors.
abstract: OBJECTIVE
  "Long-term epilepsy associated tumors (LEATs)" by definition are tumors primarily causing drug-resistant seizures for two years or more. They include low-grade glial and glioneuronal tumors with normal life expectancy. We studied a large cohort of patients with LEATs who underwent surgery through our epilepsy program.
  
  
  METHODS
  From 1998-2011, 105 patients with LEATs underwent surgery in our center. We utilized their data archived in a prospective registry to evaluate their electro-clinical-imaging characteristics affecting the long-term seizure outcome.
  
  
  RESULTS
  Of 105 patients (age 3-50 years), mean age at surgery was 20 years and mean pre-surgical duration of epilepsy was 10.9 years. 66 (62.8%) had secondary generalized seizures. 82 had temporal tumors, 23 had extra temporal (13 frontal, 3 parietal, 2 occipital and 5 multilobar lesions) and four had associated hippocampal sclerosis. The interictal discharges and ictal onset were concordant to the lesion in 82 (78%) and 98 (93%) patients respectively. Lesionectomy and/or adjoining corticectomy or temporal lobectomy was done. Ganglioglioma was the most dominant pathological substrate in 61 (58%). During a mean follow-up of 7.5 years (range 3-16 years), 78/105 (74.2%) were seizure-free and 45 (57.4%) were totally off drugs. Secondary generalized seizures (p-0.02), temporal location of tumor (p-0.008) and spikes in third month post-operative EEG (p-0.03) caused unfavorable seizure outcome. A pre-surgical duration of epilepsy of more than 6.6 years caused less than optimal surgical outcome
  
  
  CONCLUSIONS
  Early surgery should be considered a priority in LEATs. Presence of secondary generalized seizures is the single most important predictor of a poor seizure outcome.
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India. Electronic address: drashalatha@sctimst.ac.in.
authors.forename: Ashalatha
authors.initials: A
authors.lastname: Radhakrishnan
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors.forename: Mathew
authors.initials: M
authors.lastname: Abraham
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors.forename: George
authors.initials: G
authors.lastname: Vilanilam
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors.forename: Ramshekhar
authors.initials: R
authors.lastname: Menon
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Menon
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Kumar
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors.forename: Ajith
authors.initials: A
authors.lastname: Cherian
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors.forename: Neelima
authors.initials: N
authors.lastname: Radhakrishnan
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors.forename: Chandrashekharan
authors.initials: C
authors.lastname: Kesavadas
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors.forename: Bejoy
authors.initials: B
authors.lastname: Thomas
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors.forename: Sankara P
authors.initials: SP
authors.lastname: Sarma
authors.affiliation: R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors.forename: Sanjeev V
authors.initials: SV
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012640:Seizures / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
keywords: LEATs; Resective surgery; Seizure outcome