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J Neurol Neurosurg Psychiatry 2002;73:486-494 doi:10.1136/jnnp.73.5.486
  • Paper

Long term outcome of temporal lobe epilepsy surgery: analyses of 140 consecutive patients

  1. L Jutila1,
  2. A Immonen3,
  3. E Mervaala4,
  4. J Partanen4,
  5. K Partanen5,
  6. M Puranen5,
  7. R Kälviäinen1,
  8. I Alafuzoff6,
  9. H Hurskainen3,
  10. M Vapalahti3,
  11. A Ylinen2
  1. 1Department of Neurology, University of Kuopio, Kuopio, Finland
  2. 2Department of Neurology, University of Kuopio
  3. 3Department of Neurosurgery, Kuopio University Hospital
  4. 4Department of Clinical Neurophysiology, Kuopio University Hospital
  5. 5Department of Clinical Radiology, Kuopio University Hospital
  6. 6Department of Pathology, Kuopio University Hospital
  1. Correspondence to:
 Dr L Jutila, Department of Neurology, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland;
 leena.jutila{at}kuh.fi
  • Received 26 November 2001
  • Accepted 12 July 2002
  • Revised 26 June 2002

Abstract

Objective: To analyse the long term results of temporal lobe epilepsy surgery in a national epilepsy surgery centre for adults, and to evaluate preoperative factors predicting a good postoperative outcome on long term follow up.

Methods: Longitudinal follow up of 140 consecutive adult patients operated on for drug resistant temporal lobe epilepsy.

Results: 46% of patients with unilateral temporal lobe epilepsy became seizure-free, 10% had only postoperative auras, and 15% had rare seizures on follow up for (mean (SD)) 5.4 (2.6) years, range 0.25 to 10.5 years. The best outcome was after introduction of a standardised magnetic resonance (MR) imaging protocol (1993–99): in unilateral temporal lobe epilepsy, 52% of patients became seizure-free, 7% had only postoperative auras, and 17% had rare seizures (median follow up 3.8 years, range 0.25 to 6.5 years); in palliative cases (incomplete removal of focus), a reduction in seizures of at least 80% was achieved in 71% of cases (median follow up 3.1 years, range 1.1 to 6.8 years). Most seizure relapses (86%) occurred within one year of the operation, and outcome at one year did not differ from the long term outcome. Unilateral hippocampal atrophy with or without temporal cortical atrophy on qualitative MR imaging (p < 0.001, odds ratio (OR) 5.2, 95% confidence interval (CI) 2.0 to 13.7), other unitemporal structural lesions on qualitative MR imaging (p ≤ 0.001, OR 6.9, 95% CI 2.2 to 21.5), onset of epilepsy before the age of five years (p < 0.05, OR 2.9, 95% CI 1.2 to 7.2), and focal seizures with ictal impairment of consciousness and focal ictal EEG as a predominant seizure type (p < 0.05, OR 3.4, 95% CI 1.2 to 9.1) predicted Engel I–II outcome. Hippocampal volume reduction of at least 1 SD from the mean of controls on the side of the seizure onset (p < 0.05, OR 3.1, 95% CI 1.1 to 9.2) also predicted Engel I–II outcome.

Conclusions: Outcome at one year postoperatively is highly predictive of long term outcome after temporal lobe epilepsy surgery. Unitemporal MR imaging abnormalities, early onset of epilepsy, and seizure type predominance are factors associated with good postoperative outcome.

Footnotes

  • Competing interests: none declared.

  • See editorial commentary, page 470

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