title: Remote preoperative tonic-clonic seizures do not influence outcome after surgery for temporal lobe epilepsy.
abstract: OBJECTIVE
  Tonic-clonic seizures are associated with greater chance of seizure relapse after anterior temporal lobectomy. We investigated whether the interval between the last preoperative tonic-clonic seizure and surgery relates to seizure outcome in patients with drug-resistant mesial temporal lobe epilepsy (MTLE).
  
  
  METHODS
  In this retrospective study, patients were prospectively registered in a database from 1986 through 2014. Postsurgical outcome was categorized as seizure freedom or relapse. The relationship between surgical outcome and the interval between the last preoperative tonic-clonic seizure and surgery was investigated.
  
  
  RESULTS
  One-hundred seventy-one patients were studied. Seventy nine (46.2%) patients experienced tonic-clonic seizures before surgery. Receiver operating characteristic curve of timing of the last preoperative tonic-clonic seizure was a moderate indicator to anticipate surgery failure (area under the curve: 0.657, significance; 0.016). The best cutoff that maximizes sensitivity and specificity was 27months; with a sensitivity of 0.76 and specificity of 0.60. Cox-Mantel analysis confirmed that the chance of becoming free of seizures after surgery in patients with no or remote history of preoperative tonic-clonic seizures was significantly higher compared with patients with a recent history (i.e., in 27months before surgery) (p=0.0001).
  
  
  CONCLUSIONS
  The more remote the occurrence of preoperative tonic-clonic seizures, the better the postsurgical seizure outcome, with at least a two year gap being more favorable. A recent history of tonic-clonic seizures in a patient with MTLE may reflect more widespread epileptogenicity extending beyond the borders of mesial temporal structures.
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: aliasadipooya@yahoo.com.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Asadi-Pooya
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: amin.rabiei@jefferson.edu.
authors.forename: Amin H
authors.initials: AH
authors.lastname: Rabiei
authors.affiliation: School of Public Health, Drexel University, Philadelphia, PA, USA. Electronic address: Edward.Gracely@DrexelMed.edu.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Gracely
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: michael.sperling@jefferson.edu.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Sperling
mesh_terms: D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000379:methods; D000069279:Drug Resistant Epilepsy / Q000601:surgery; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D004830:Epilepsy, Tonic-Clonic / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
keywords: Epilepsy surgery; Hippocampal sclerosis; Partial seizures; Risk factors; Tonic-clonic seizure