title: Preoperative prediction of temporal lobe epilepsy surgery outcome.
abstract: There is controversy about relative contributions of ictal scalp video EEG recording (vEEG), routine scalp outpatient interictal EEG (rEEG), intracranial EEG (iEEG) and MRI for predicting seizure-free outcomes after temporal lobectomy. We reviewed NIH experience to determine contributions at specific time points as well as long-term predictive value of standard pre-surgical investigations.
  
  
  
  Raw data was obtained via retrospective chart review of 151 patients. After exclusions, 118 remained (median 5 years follow-up). MRI-proven mesial temporal sclerosis (MTSr) was considered a separate category for analysis. Logistic regression estimated odds ratios at 6-months, 1-year, and 2 years; proportional hazard models estimated long-term comparisons. Subset analysis of the proportional hazard model was performed including only patients with commonly encountered situations in each of the modalities, to maximize statistical inference.
  
  
  
  Any MRI finding, MRI proven MTS, rEEG, vEEG and iEEG did not predict two-year seizure-free outcome. MTSr was predictive at six months (OR=2.894, p=0. 0466), as were MRI and MTSr at one year (OR=10.4231, p=0. 0144 and OR=3.576, p=0. 0091). Correcting for rEEG and MRI, vEEG failed to predict outcome at 6 months, 1year and 2 years. Proportional hazard analysis including all available follow-up failed to achieve significance for any modality. In the subset analysis of 83 patients with commonly encountered results, vEEG modestly predicted long-term seizure-free outcomes with a proportional hazard ratio of 1.936 (p=0.0304).
  
  
  
  In this study, presurgical tools did not provide unambiguous long-term outcome predictions. Multicenter prospective studies are needed to determine optimal presurgical epilepsy evaluation.
authors.affiliation: Clinical Epilepsy Section, NINDS, NIH, United States. Electronic address: daniel.goldenholz@nih.gov.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Goldenholz
authors.affiliation: Clinical Epilepsy Section, NINDS, NIH, United States.
authors.forename: Alexander
authors.initials: A
authors.lastname: Jow
authors.affiliation: Clinical Epilepsy Section, NINDS, NIH, United States; Office of the Clinical Director, NINDS, NIH, United States.
authors.forename: Omar I
authors.initials: OI
authors.lastname: Khan
authors.affiliation: Clinical Epilepsy Section, NINDS, NIH, United States.
authors.forename: Anto
authors.initials: A
authors.lastname: Bagić
authors.affiliation: Electroencephalography Section, NINDS, NIH, United States.
authors.forename: Susumu
authors.initials: S
authors.lastname: Sato
authors.affiliation: Clinical Neurosciences Program, NINDS, NIH, United States.
authors.forename: Sungyoung
authors.initials: S
authors.lastname: Auh
authors.affiliation: Neurosurgical Biology and Therapeutics Section, NINDS, NIH, United States.
authors.forename: Conrad
authors.initials: C
authors.lastname: Kufta
authors.affiliation: Electroencephalography Section, NINDS, NIH, United States.
authors.forename: Sara
authors.initials: S
authors.lastname: Inati
authors.affiliation: Clinical Epilepsy Section, NINDS, NIH, United States.
authors.forename: William H
authors.initials: WH
authors.lastname: Theodore
mesh_terms: D000328:Adult; D038481:Anterior Temporal Lobectomy; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012598:Sclerosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D012640:Seizures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: Epilepsy; Long term monitoring; MRI; Outcomes; Surgery; Video EEG