Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome.

Temporal lobe epilepsy (TLE) accompanied by hippocampal sclerosis (HS) is the type of epilepsy most frequently operated on. The predictors for long-term seizure freedom after surgery of TLE-HS are unknown. In this study, we aimed to identify prognostic factors which predict the outcome 6 months and 2, 3 and 5 years after epilepsy surgery of TLE-HS. Our working hypothesis was that the prognostic value of potential predictors depended on the post-operative time interval for which the assessment was made. We included 171 patients (100 females and 71 males, aged 16-59 years) who had undergone presurgical evaluation, including video-EEG, who had had MRI-defined HS, and who had undergone temporal lobectomy. We found that secondarily generalized seizures (SGTCS) and ictal dystonia were associated with a worse 2-year outcome. Both these variables together with older age and longer epilepsy duration were also related to a worse 3-year outcome. Ictal limb dystonia, older age and longer epilepsy duration were associated with long-term surgical failure evaluated 5 years post-operatively. In order to determine the independent predictors of outcomes, we calculated multivariate analyses. The presence of SGTCS and ictal dystonia independently predicted the 2-year outcome. Longer epilepsy duration and ictal dystonia predicted the 3-year outcome. Longer epilepsy duration (P = 0.003) predicted a poor 5-year outcome. Conclusively, predictors for the long-term surgical results of TLE with HS are different from those variables that predict the short-term outcome. Epilepsy duration is the most important predictor for long-term surgical outcome. Our results strongly suggest that surgery for TLE-HS should be performed as early as possible.

[1]  O. Witte,et al.  Bilateral reductions of hippocampal volume, glucose metabolism, and Wada hemispheric memory performance are related to the duration of mesial temporal lobe epilepsy , 1999, Journal of Neurology.

[2]  Alon Friedman,et al.  Long-term seizure outcomes following amygdalohippocampectomy. , 2003, Journal of neurosurgery.

[3]  S. Noachtar,et al.  Clinical features and EEG findings differentiating mesial from neocortical temporal lobe epilepsy. , 2002, Epileptic disorders : international epilepsy journal with videotape.

[4]  H. Lüders,et al.  Speech manifestations in lateralization of temporal lobe seizures , 1989, Annals of neurology.

[5]  H. Lüders,et al.  Presurgical evaluation of epilepsy. , 2001, Brain : a journal of neurology.

[6]  F W Sharbrough,et al.  Improvement and Deterioration of Seizure Control During the Postsurgical Course of Epilepsy Surgery Patients , 1999, Epilepsia.

[7]  Y. Løyning,et al.  Predictive Factors for Success in Surgical Treatment for Partial Epilepsy: A Multivariate Analysis , 1994, Epilepsia.

[8]  H. Jokeit,et al.  EEG predicts surgical outcome in lesional frontal lobe epilepsy , 2000, Neurology.

[9]  J. Zentner,et al.  Surgical treatment of epilepsies. , 2002, Acta neurochirurgica. Supplement.

[10]  P. Rutecki,et al.  The nature and course of neuropsychological morbidity in chronic temporal lobe epilepsy , 2004, Neurology.

[11]  F. Andermann,et al.  Temporal Lobe Epilepsy After Prolonged Febrile Convulsions: Excellent Outcome After Surgical Treatment , 1993, Epilepsia.

[12]  T. W. May,et al.  Cerebellar atrophy and prognosis after temporal lobe resection. , 1997, Journal of neurology, neurosurgery, and psychiatry.

[13]  S Shinnar,et al.  How long does it take for partial epilepsy to become intractable? , 2003, Neurology.

[14]  P. Bladin.  Post-temporal lobectomy seizures. , 1987, Clinical and experimental neurology.

[15]  H. Lüders,et al.  Interictal EEG and Ictal Scalp EEG Propagation Are Highly Predictive of Surgical Outcome in Mesial Temporal Lobe Epilepsy , 2000, Epilepsia.

[16]  I Savic,et al.  Pattern of interictal hypometabolism in PET scans with fludeoxyglucose F 18 reflects prior seizure types in patients with mesial temporal lobe seizures. , 1997, Archives of neurology.

[17]  N. Ebrahimi,et al.  Initial outcomes in the Multicenter Study of Epilepsy Surgery , 2003, Neurology.

[18]  Jerome Engel,et al.  Outcome with respect to epileptic seizures. , 1993 .

[19]  A. Ebner,et al.  Lateralizing semiology predicts the seizure outcome after epilepsy surgery in the posterior cortex. , 2002, Brain : a journal of neurology.

[20]  W T Blume,et al.  A randomized, controlled trial of surgery for temporal-lobe epilepsy. , 2001, The New England journal of medicine.

[21]  S Rabe-Hesketh,et al.  Predictors of outcome and pathological considerations in the surgical treatment of intractable epilepsy associated with temporal lobe lesions , 2001, Journal of neurology, neurosurgery, and psychiatry.

[22]  J. McNamara,et al.  Seizure outcome after temporal lobectomy for temporal lobe epilepsy , 2000, Neurology.

[23]  J. Girvin,et al.  Effectiveness of temporal lobectomy measured by yearly follow-up and multivariate analysis , 1994 .

[24]  S. Berkovic,et al.  Seizure Outcome after Temporal Lobectomy: Current Research Practice and Findings , 2001, Epilepsia.

[25]  J. Engel,et al.  The timing of surgical intervention for mesial temporal lobe epilepsy: a plan for a randomized clinical trial. , 1999, Archives of neurology.

[26]  M. Brázdil,et al.  Ictal limb dystonia in temporal lobe epilepsy. An invasive video‐EEG finding , 2003, European journal of neurology.

[27]  G. Ojemann,et al.  Outcome following surgery in patients with bitemporal interictal epileptiform patterns , 1997, Neurology.

[28]  T. Rasmussen,et al.  Prognostic factors in the surgical treatment of temporal lobe epileptics , 1968, Neurology.

[29]  A. Ebner,et al.  Clinical features and surgical outcome of medial temporal lobe epilepsy with a history of complex febrile convulsions , 2003, Epilepsy Research.

[30]  A. Kaye,et al.  Seizure Frequency and Duration of Epilepsy are Not Risk Factors for Postoperative Seizure Outcome in Patients with Hippocampal Sclerosis , 1999, Epilepsia.

[31]  D. Spencer,et al.  Characteristics of medial temporal lobe epilepsy: I. Results of history and physical examination , 1993, Annals of neurology.

[32]  W. Blume.  Clinical and electroencephalographic correlates of the multiple independent spike foci pattern in children , 1978, Annals of neurology.

[33]  G. Jackson,et al.  Preoperative MRI predicts outcome of temporal lobectomy , 1995, Neurology.

[34]  H. Wieser,et al.  Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis , 2004 .

[35]  Christian E Elger,et al.  Prognostic factors and outcome after different types of resection for temporal lobe epilepsy. , 2002, Journal of neurosurgery.

[36]  C. Adam,et al.  Association of ipsilateral motor automatisms and contralateral dystonic posturing: a clinical feature differentiating medial from neocortical temporal lobe epilepsy. , 1999, Archives of neurology.

[37]  Y. Løyning,et al.  Surgical Treatment for Partial Epilepsy Among Norwegian Adults , 1994, Epilepsia.

[38]  G. Ojemann,et al.  Factors Predicting Outcome of Surgery for Intractable Epilepsy with Pathologically Verified Mesial Temporal Sclerosis , 2003, Epilepsia.

[39]  F. Gilliam,et al.  Lost years , 2003, Neurology.

[40]  Jacqueline A. French,et al.  Characteristics of medial temporal lobe epilepsy , 1993 .

[41]  D C Reutens,et al.  Dystonia, clinical lateralization, and regional blood flow changes in temporal lobe seizures , 1992, Neurology.

[42]  G. Ojemann,et al.  Multidisciplinary prediction of seizure relief from cortical resection surgery , 1986, Annals of neurology.

[43]  D. Spencer,et al.  Long-term seizure outcome in patients initially seizure-free after resective epilepsy surgery , 2003, Neurology.

[44]  C. Binnie,et al.  Failed surgery for epilepsy. A study of persistence and recurrence of seizures following temporal resection. , 2000, Brain : a journal of neurology.

[45]  M. Doherty.  How long does it take for partial epilepsy to become intractable? , 2003, Neurology.

[46]  C R Jack,et al.  Predictors of outcome of anterior temporal lobectomy for intractable epilepsy , 1998, Neurology.

[47]  S. Benbadis.  Is the underlying cause of epilepsy a major prognostic factor for recurrence? , 1999, Neurology.

[48]  T. Rasmussen.  The Neurosurgical Treatment of Focal Epilepsy , 1970 .

[49]  I. Najm,et al.  Ganglioglioma and Intractable Epilepsy: Clinical and Neurophysiologic Features and Predictors of Outcome After Surgery , 1998, Epilepsia.

[50]  H. Lüders,et al.  Dystonic posturing in complex partial seizures of temporal lobe onset , 1989, Neurology.

[51]  K. Kanemoto,et al.  Characteristics and treatment of temporal lobe epilepsy with a history of complicated febrile convulsion , 1998, Journal of neurology, neurosurgery, and psychiatry.

[52]  C. Chung,et al.  Prognostic Factors in Anterior Temporal Lobe Resections for Mesial Temporal Lobe Epilepsy: Multivariate Analysis , 1999, Epilepsia.

[53]  J. Engel,et al.  Long-term follow-up after temporal lobe resection for lesions associated with chronic seizures , 1997, Neurology.