Prognostic factors in mesial temporal lobe epilepsy surgery

Abstract

-Eighty-four patients submitted to anterior temporal lobectomy were evaluated retrospectively in order to correlate the different type of simple partial seizure (SPS) and their prognostic implications in patients with mesial temporal sclerosis. The patients were divided in two groups following the classification of Engel; Group 1 (53 patients) included patients Class I (without seizures or of good outcome) and Group 2 (31 patients) included Classes II, III and IV (with seizures or of bad outcome). The two groups were compared and results showed no statistical difference in relation to the demographic aspects as sex, side of surgery, age at onset of seizures and time of the patients' postoperative follow-up. Statistical analysis revealed no relationship between type of SPS and outcome. SPS did not show a statistical value in localizing the side of pathology. However, when the two groups were compared statistically in terms of patients' ages at the time of surgery, and the time elapsed from the onset of the seizures to the surgical intervention, it was observed that Group 1 (of good outcome) had seizures for smaller interval (p <0.05) and was operated at an earlier age (p<0.02) than Group 2 (of bad outcome). The presence or the type of SPS can not be used as a prognostic measure; surgical therapy must be considered as soon as clinical resistance is demonstrated.KEY WORDS: simple partial seizure, hippocampal sclerosis, mesial temporal sclerosis, temporal epilepsy, epilepsy surgery. Fatores prognósticos na cirurgia da epilepsia do lobo temporal mesialRESUMO -Oitenta e quatro pacientes submetidos a lobectomia temporal anterior foram avaliados retrospectivamente com o intuito de correlacionar os diferentes tipos de crises parcias simples (CPS) e suas implicações prognósticas nos pacientes com esclerose mesial temporal. Os pacientes foram divididos em dois grupos de acordo com a classificação de Engel: o Grupo 1 (53 pacientes) englobando os pacientes Classe I (sem crises ou de boa evolução) e o Grupo 2 (31 pacientes) abrangendo as Classes II, III, IV (com crises ou de má evolução). Os grupos foram comparados e os resultados mostraram não haver diferença estatística, quanto aos aspectos demográficos como sexo, lado da cirurgia, idade de início das crises e tempo de acompanhamento pós-operatório dos pacientes. A análise estatística não mostrou relação entre evolução clínica e o tipo de CPS, assim como não mostraram as CPS ter um valor na localização do lado acometido. No entanto, quando os dois grupos foram comparados estatisticamente com relação às idades dos pacientes na ocasião da cirurgia e ao tempo decorrido a partir do início das crises até a intervenção cirúrgica, observou-se que o Grupo 1 (de melhor evolução) conviveu com as crises por intervalo de tempo menor (p<0,05) e realizou as cirurgias em idades mais precoces (p<0,02) do que as correspondentes do Grupo 2 (de pior evolução). A presença ou o tipo de CPS não pode ser um fator usado na determinação prognóstica; a cirurgia deve ser considerada tão brev...

Resective Surgery for Intractable Focal Epilepsy in Patients with Low IQ: Predictors for Seizure Control and Outcome with Respect to Seizures and Neuropsychological and Psychosocial Functioning

“…1). This suggestion is in agreement with findings in several studies in intellectually unselected groups of patients (48–52). However, some studies failed to find a relation between duration of epilepsy and outcome (53–56).…”

A volumetric MRI study of the hippocampus and the parahippocampal region after unilateral medial temporal lobe resection

“…While unilateral hippocampal atrophy is indicator of good surgical prognosis in patients with temporal lobe epilepsy, some patients do not become seizure free after surgery (Berkovic et al, 1995;Prevedello et al, 2000). Our post-operative MRI analysis might help assess a possible role for remaining TPC, EC, PRC and PHC in recurrent seizures.…”

Shorter epilepsy duration is associated with better seizure outcome in temporal lobe epilepsy surgery

“…Additionally, Sirven et al 21 studied a large number of patients undergoing temporal lobectomy and observed that patients younger than 50 years had a higher likelihood of seizure freedom compared with those older than 50 years, although the procedure was considered safe and beneficial in both groups. Conversely, a Brazilian investigation reported no statistical difference of age at surgery with regard to postsurgical outcome after temporal lobectomy 22 . We did not observe a statistical difference regarding outcomes between patients younger and older than 50 years at the time of surgery (Table 5); the procedure proved to be safe and beneficial to both groups, which is in accordance with the literature 21 .…”

“…Other studies have observed that a longer epilepsy duration before surgical treatment predicted worse seizure outcome 19,22 . However, Baldauf et al did not reach those conclusions 24 .…”

“…Postoperative outcome distribution according to age. Age I II III IV Total 10-19 7 3 0 3 13 20-29 21 3 1 2 27 30-39 39 17 5 8 69 40-49 44 18 4 4 70 50-59 28 11 1 0 40 60-69 5 4 0 1 10 Total 144 56 11 18 229 in other brain areas not involved in the primary epileptogenic zone, and this could be associated with the persistence of disabling seizures 19,20,21,22,23,24 . However, further clinical and experimental investigations are necessary to validate this hypothesis.…”