Long-term outcome after temporal lobe surgery—Prediction of late worsening of seizure control

Abstract

We analyzed possible predictors of late worsening of seizure control in 94 adult patients who had anterior temporal lobectomy (ATL) from the Epilepsy Center of the National Institute of Psychiatry and Neurology, Budapest between 1985 and 2001. We evaluated data regarding epilepsy, presurgical evaluation, pre- and postoperative EEG, structural imaging, histology and operative complications. The mean follow-up was 6.1 years (range: 2-17 years). The outcome was measured as Engel class, the time to the first seizure and the longest seizure free period. Multiple regression analysis was used to assess predictors. Seizure free outcome was achieved in 72% of the patients 1-year after surgery. Eighty-seven percent of them remained seizure free at the second year of follow-up, 74% at the fifth, and 67% at the tenth year of follow-up. After 2 years of follow-up improvement was present in 3%, worsening in 18% of the patients. Factors associated with long-term worsening were: postoperative ipsilateral EEG spikes over the resected side, preoperative bilateral interictal discharges, cortical dysplasia of Taylor's type, and ictal contralateral propagation. In these patients, even in seizure free state, therapy reduction might be inappropriate.

Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy

“…ATL has been reported to results in seizure free rates at 1 to 2 years, ranging from about 60% to 80% [20][21][22][23][24]. Seizure-free rates are even higher in patients with MTS [22,24], and about 90% of the patients report significant improvement in seizure control after ATL.…”

Deep brain stimulation for medically refractory epilepsy

“…An average reduction in seizure frequency of 67% (range 44-94%), was noted during the sham interval. Once the stimulators were turned on, a 49% (range 35-76%) reduction in seizure frequency was noted over the subsequent follow-up period (mean 43.8 months, range [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. In 1 patient the stimulator was inadvertently turned off during months 7-12, during which period the seizure frequency increased compared to baseline.…”

“…After temporal lobectomy, the recurrence rate of seizures after a long period of seizure freedom is as high as 15%. 37 Given that some of these patients must undergo implantation of electrodes prior to considering resection (due to inconsistencies in noninvasive evaluations), they may be ideal candidates for using MTL DBS with the same electrodes that were used for diagnostic purposes.…”

Langzeit-Outcome nach epilepsiechirurgischen Eingriffen

“…Der Anteil der ohne antikonvulsive Medikation anfallsfreien Patienten stieg von 36% in den ersten fünf postoperativen Jahren auf 40-43% nach 7-11 Jahren, signifikante Unterschiede der Rezidivraten zwischen Patienten mit und ohne Weiterführung der antikonvulsiven Medikation fanden sich nicht [49]. • Kelemen et al [26] verfolgten 94 Patienten mit TLE, die 1985-2001 mittels anteriorer Temporallappenresektion behandelt wurden, über einen mittleren Zeitraum von 6,1 Jahren. Ein Outcome nach Engel I erreichten nach einem Jahr 56%, nach zwei Jahren 66%, nach fünf Jahren 59% und bei letztem Follow-up 56%.…”