Abstracts

We studied the surgical outcome in a group of patients with medically refractory seizure disorders using two different classifications, the standard Engle classification, and the prosposed outcome scale suggested by the Commission on Neurosurgery of the International League Against Epilepsy(ILAE).
We reviewed case records of eighty-six (86) patients (42 females, 44 males) who underwent surgical treatment for medically intractable epilepsy.There were seven patients who had frontal lobe resections, and (79)patients with temporal lobectomies. Follow up duration was for 3-10 years. We compared two different classification systems, the standard Engle outcome scale, and the recently proposed ILAE scale.
Using the Engle scale with the time evaluated being the most recent follow up, 60.5% of patients were class-1(free of disabling seizure), 4.7% class-2(rare disabling seizures), 32.6% class-3(worthwhile improvement), and 2.4% class-4(no worthwhile improvement).
With the ILAE scale patients are evaluated on a yearly basis. Using this system, 62.4% were class-1 ( completely seizure free after surgery ) at year one, with 44.9% class-1 at year five. 3.5% were class-2 (only auras, no other seizures) at year one compared to 7.2% at year five. 9.4% were class-3 (1-3 seizure days per year) at year one ,with 14.5% at year five. Class-4 (less than 50% reduction of seizure days) showed 22.4% at year one vs.29% at year five. Class-5 (less than 50% reduction of baseline seizure days to 100% increase from baseline) was 2.5% at year one, and 4.3% at year five.
The proposed ILAE outcome scale allows a more dynamic evaluation of seizure surgery outcomes.
Patients do change categories from year to year and this system gives a more accurate reflection of that fact than amore static assessment scale.