title: Predictors of Postoperative Seizure Recurrence: A Longitudinal Study of Temporal and Extratemporal Resections.
abstract: Objective. We investigated the longitudinal outcome of resective epilepsy surgery to identify the predictors of seizure recurrence. Materials and Methods. We retrospectively analyzed patients who underwent resections for intractable epilepsy over a period of 7 years. Multiple variables were investigated as potential predictors of seizure recurrence. The time to first postoperative seizure was evaluated using survival analysis and univariate analysis at annual intervals. Results. Among 70 patients, 54 (77%) had temporal and 16 (23%) had extratemporal resections. At last follow-up (mean 48 months; range 24-87 months), the outcome was Engel class I in 84% (n = 59) of patients. Seizure recurrence followed two patterns: recurrence was "early" (within 2 years) in 82% of patients, of whom 83% continued to have seizures despite optimum medical therapy; recurrence was "late" (after 2 years) in 18%, of whom 25% continued to have seizures subsequently. Among the variables of interest, only resection site and ictal EEG remained as independent predictors of seizure recurrence over the long term (p < 0.05). Extratemporal resection and discordance between ictal EEG and resection area were associated with 4.2-fold and 5.6-fold higher risk of seizure recurrence, respectively. Conclusions. Extratemporal epilepsy and uncertainty in ictal EEG localization are independent predictors of unfavorable outcome. Seizure recurrence within two years of surgery indicates poor long-term outcome.
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Comprehensive Epilepsy Center, NYU Langone Medical Center, New York, NY 10016, USA.
authors.forename: Hai
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Seton Brain and Spine Institute, The University of Texas at Austin, Austin, TX 78701, USA.
authors.forename: Pradeep N
authors.initials: PN
authors.lastname: Modur
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
authors.forename: Niravkumar
authors.initials: N
authors.lastname: Barot
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Department of Neurology, Baylor College of Medicine Medical Center, Houston, TX 77030, USA.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Van Ness
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Agostini
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
authors.forename: Kan
authors.initials: K
authors.lastname: Ding
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Neurology Consultants of Dallas, PA, Dallas, TX 75231, USA.
authors.forename: Puneet
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Hays
authors.affiliation: Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Mickey