Brain Advance Access originally published online on January 5, 2005
Brain 2005 128(2):395-404; doi:10.1093/brain/awh358
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Brain Vol. 128 No. 2 © Guarantors of Brain 2005; all rights reserved
Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome
1 National Institute of Psychiatry and Neurology and 2 Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary, 3 Epilepsy Centre Bethel, Bielefeld, Germany and 4 Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
Correspondence to: Dr Jozsef Janszky or Dr Alois Ebner, Epilepsie-Zentrum Bethel, Klinik Mara I, Maraweg 21, Bielefeld 33617, Germany E-mail: janszky{at}index.hu or ae{at}mara.de
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.
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