Clinical characteristics and predictive factors in 98 patients with complex partial seizures treated with temporal resection.

OBJECTIVE To analyze the preoperative and operative factors predictive of outcome in patients undergoing surgery for temporal lobe epilepsy. DESIGN From 1984 to 1992, 98 patients with medically refractory temporal lobe epilepsy underwent surgery. Evaluation included the following: video electroencephalography (13 patients had intracranial recordings), head magnetic resonance imaging, interictal and ictal single photon emission computed tomography, psychometric testing, and Wada testing. Seizure-free groups and non-seizure-free groups were analyzed. Follow-up of 1 year to 8 years was available for 89 patients (mean, 3.2 years). SETTING Indiana University Epilepsy Surgery Program, Indianapolis. OUTCOME Sixty percent (53/89) were seizure free, 16% (14/89) had rare seizures, 13% (12/89) had worthwhile improvement, and 11% (10/89) showed no improvement. Forty-two percent of seizure-free patients had a history of febrile seizures compared with 5% of non-seizure-free patients. Ictal single photon emission computed tomography showed increased flow on the side of seizure onset in 86% of seizure-free patients compared with 62% of non-seizure-free patients. Ninety-seven percent of seizure-free patients had a pathologic diagnosis; mesial temporal structures were identified in 61%. Only 64% of non-seizure-free patients had a pathologic diagnosis, and mesial temporal structures were identified in only 36% of non-seizure-free patients. CONCLUSIONS Eighty-nine percent (79/89) of our patients benefited from surgery. The following factors were predictive of good outcome: a history of febrile seizures; ictal single photon emission computed tomography showing increased blood flow ipsilateral to the epileptogenic zone; a pathologic diagnosis; and the presence of mesial temporal structures in the resected tissue.