LONG-TERM SURGICAL OUTCOME IN TEMPORAL LOBE EPILEPSY DUE TO HIPPOCAMPAL SCLEROSIS (TLE/HS): A SURVIVAL ANALYSIS SPANNING 9 YEARS
Abstract number :
3.241
Submission category :
Year :
2002
Submission ID :
1495
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Eliseu Paglioli-Neto, Andre Palmini, Jaderson Costa da Costa, Eduardo Paglioli, Victor Martinez, Ney Azambuja, Mirna Portuguez, Gilberto Trentin, Maria-Elisa Calcagnotto, Ligia Coutinho, Sergio Raupp, Jo[atilde]o-Rubi[atilde]o Hoefel-Filho. Porto Alegre E
RATIONALE: Subsyndromic specificity allows and calls for the delineation of reliable long-term outcome expectations in patients undergoing epilepsy surgery . Survival analyses of patients remaining in strict outcome classes may help with such delineation.
This work aimed at evaluating the stability of surgical results over the years in a consecutive series of patients undergoing surgery for TLE/ HS. In addition, it looked for the variables potentially associated with the best scenarios regarding long-term seizure control.
METHODS: Yearly data on the degree of seizure control was prospectively collected for 131 patients with TLE/ HS followed for 1 to 9 years after operation. Number of patients included in the analysis for years 1 to 9 were, respectively, 131, 115, 82, 66, 52, 34, 20, 12, and 5. All had unilateral HS unequivocally detected by preoperative MRI and/or postoperative histopathology. Seventy-seven underwent an anterior temporal lobectomy (ATL) and 54 a selective amygdalohippocampectomy (SAH). Engel[scquote]s outcome classification was used to analyze the surgical results.
RESULTS: Survival in outcome class I for years 1 to 9 was seen, respectively, in 91%, 91%, 89%, 89%, 89% 84%, 84%, 84%, 84% of the patients, with a mean survival time of 8.58 years (CI 8,02 [ndash] 9,14). More specifically, survival in outcome class IA was seen in 83%, 77%, 77%, 73%, 71%, 71%, 71%, 71%, and 71% in the same time period (mean survival, 7.08 years ; CI 6,37 [ndash] 7,79). For those patients who remained in outcome class IA after the first postoperative year, there was a 93% probability of retaining this result for the remainder of the follow up period (mean survival 8,51 years; CI: 7,94 [ndash] 9,09). Younger age at epilepsy onset (p=0.02) and a greater than 90% lateralization of interictal spikes (p=0.01) were the only variables significantly associated with outcome class IA at last visit, in comparison with all other outcome classes. No significant correlations were found for outcome class I with demographic or neurophysiologic variables, in comparison with all other less favorable results. Surgical results did not significantly differ in patients who underwent an ATL in comparison with those who had a SAH.
CONCLUSIONS: When adequate resection of mesial temporal lobe structures is performed, clearcut clinical and MRI delineation of TLE/HS is strongly suggestive of a most favorable and stable postoperative long-term course, irrespective of other variables.
[Supported by: FAPERGS]