Background We report the clinical characteristics and outcome of epilepsy surgery in adult patients with intractable epilepsy due to isolated lesional temporal lobe epilepsy (TLE).
Methods Retrospective analysis of clinical and outcome characteristics in 47 consecutive adult patients with intractable epilepsy due to isolated lesional TLE who underwent epilepsy surgery from November 2009 to January 2015 was done to predictors of outcome.
Results The mean age at surgery of the study population was 30.74 ± 10.85 years with 20 (43.5%) women. While the average age at onset of epilepsy was 20.12 ± 12.52 years, average duration of epilepsy was 10.78 ± 7.96 years. Favourable Engels outcome was observed in 39 (84.8%) of the patients. Findings on histopathology reported glioma in 24 (52.0%) of the patients. On comparing patients with favourable outcome (n = 39) with those with unfavourable outcome (n = 7), age at surgery was significantly higher in patients with unfavourable outcome (40.14 ± 11.69 years vs 29.05 ± 9.92 years; p = 0.011). Higher percentage of patients with unfavourable outcome scored poor on pre-surgical IQ tests (42.9% vs 7.7%; p = 0.037). On further analysis for predictors of outcome, age at surgery (β = 0.858; 95% CI 0.738–0.997) significantly predicts outcome (β = 1.166; 95% CI 0.931–1.461; p = 0.182), whereas pre-surgical poor IQ showed a trend towards being associated with unfavourable outcome (β = 0.079; 95% CI 0.005–1.287; p = 0.075).
Conclusion Surgery for intractable epilepsy due to isolated lesional TLE has favourable outcome in vast majority (84.8%) of carefully selected patients. Age at surgery predicts outcome in these patients.
Keywords
Lesional temporal lobe epilepsy -
Age at surgery -
Outcome -
Glioma
References
1
Hauser WA,
Kurland LT.
The epidemiology of epilepsy in Rochester, Minnesota, 1935 through 1967. Epilepsia 16 1975; 1-66
7
Clarke DB,
Olivier A,
Andermann F.
et al. Surgical treatment of epilepsy: the problem of lesion/focus incongruence. Surg Neurol 46 1996; 579-585 discussion 585–586
8
Bancaud J,
Talairach J.
Epilepsy of the supplementary motor area: a particularly difficult diagnosis in children. Rev Neuropsychiatr Infant 13 1965; 483-499
12
Savitr Sastri BV,
Arivazhagan A,
Sinha S.
et al. Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis. J Neurol Sci 340 2014; 183-190
13
Williamson PD,
French JA,
Thadani VM.
et al. Characteristics of medial temporal lobe epilepsy: II. Interictal and ictal scalp electroencephalography, neuropsychological testing, neuroimaging, surgical results, and pathology. Ann Neurol 34 1993; 781-787
17
Hamer HM,
Najm I,
Mohamed A.
et al. Interictal epileptiform discharges in temporal lobe epilepsy due to hippocampal sclerosis versus medial temporal lobe tumors. Epilepsia 40 1999; 1261-1268
19
Hennessy MJ,
Elwes RD,
Honavar M.
et al. Predictors of outcome and pathological considerations in the surgical treatment of intractable epilepsy associated with temporal lobe lesions. J Neurol Neurosurg Psychiatry 70 2001; 450-458
20
Radhakrishnan K,
So EL,
Silbert PL.
et al. Predictors of outcome of anterior temporal lobectomy for intractable epilepsy: a multivariate study. Neurology 51 1998; 465-471
23
Li LM,
Dubeau F,
Andermann F.
et al. Periventricular nodular heterotopia and intractable temporal lobe epilepsy: poor outcome after temporal lobe resection. Ann Neurol 41 1997; 662-668