Prognostic factors in presurgical assessment of frontal lobe epilepsy
- aInstitute of Epileptology, King’s College Hospital, Denmark Hill, London SE5 9RS, UK, bFaculteit der Geneeskunde, Academic Medical Center, University of Amsterdam, The Netherlands, cDepartamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Dr Gonzalo Alarcón, Department of Clinical Neurophysiology, King’s College Hospital, Denmark Hill, London SE5 9RS, UK. Telephone 0044 171 346 5309; fax 0044 171 346 5308.
- Received 26 March 1998
- Revised 24 August 1998
- Accepted 23 September 1998
Abstract
OBJECTIVES To determine predictors for surgical outcome in the presurgical assessment of frontal lobe epilepsy.
METHODS Thirty seven patients were operated on for frontal lobe epilepsy between 1975 and 1996. Their medical records were reviewed for ictal semiology, age at onset, duration of the epilepsy, age at operation, preoperative interictal and ictal encephalographic findings, and abnormalities on neuroimaging and neuropsychological testing. In addition, type of resection and pathology were compared with surgical outcome.
RESULTS Univariate statistical analysis showed that the presence of a focal abnormality on neuroimaging was associated with favourable outcome. The presence of the following ictal findings was associated with poor outcome: autonomic manifestations, eye deviation, head version contralateral to the operated side, and bilateral or multifocal ictal onset. Fifteen patients had secondarily generalised interictal discharges and, interestingly, their presence was not associated with poor outcome. Multivariate logistic regression showed that the presence of a focal abnormality on neuroimaging was significantly associated with a favourable outcome while contralateral head version was the only variable significantly associated with poor surgical outcome.
CONCLUSIONS A focal abnormality on neuroimaging was the only variable which was significantly associated with a favourable surgical outcome, whereas contralateral head version was the most significant predictor for a poor outcome. The presence of generalised discharges before surgery was not associated with poor outcome.
