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Long-term outcome of lesional posterior cortical epilepsy surgery in adults
  1. A E Elsharkawy1,2,
  2. N M F El-Ghandour2,
  3. F Oppel3,
  4. H Pannek3,
  5. R Schulz1,
  6. M Hoppe1,
  7. F G Woermann4,
  8. M Nayel2,
  9. A Issa2,
  10. A Ebner1
  1. 1
    Department of Presurgical Evaluation, Bethel Epilepsy Centre, Bielefeld, Germany
  2. 2
    Neurosurgical Department, Cairo University, Cairo, Egypt
  3. 3
    Neurosurgical Department, Bethel Epilepsy Centre, Bielefeld, Germany
  4. 4
    MRI Unit, Bethel Epilepsy Centre, Bielefeld, Germany
  1. Dr A Ebner, Klinik Mara, Maraweg 21, 33617 Bielefeld, Germany; alois.ebner{at}mara.de

Abstract

Objective: The aim of this study was to evaluate the short- and long-term seizure outcome and to find predictors of outcome after epilepsy surgery in lesional posterior cortical epilepsies (PCEs).

Methods: The operative outcome in 80 consecutive adult patients with lesional PCEs who underwent resective surgery for intractable partial epilepsy between 1991 and 2006 was retrospectively studied.

Results: The probability of remaining in Engel Class I was 66.3% (95% CI 60 to 72) at 6 months, 52.5% (95% CI 47 to 57) at 2 years, 52.9% (CI 45 to 59) at 5 years and 47.1% (CI 42 to 52) at 10 years. Factors predicting poor outcome were the presence of a somatosensory aura, extraregional spikes, incomplete resection, interictal epileptiform discharge (IED) in EEG 6 months and 2 years postsurgery, history of generalised tonic-clonic seizure (GT-CS) and the presence of focal cortical dysplasia in the resected specimen. Factors predicting good outcome were childhood onset of epilepsy, short epilepsy duration, ipsilateral spikes, visual aura, presence of well-circumscribed lesion in preoperative MRI and a pathologically defined tumour. In the multivariate analysis, predictors were different in the long and short term as follows: incomplete resection as proven by postoperative MRI (hazard ratio (HR) 2.059 (CI 1.19 to 3.67)) predicts seizure relapse in short-term follow-up. The presence of IED in the EEG performed 6 months after surgery (HR 2.3 (CI 1.128 to 4.734)) predicts seizure relapse in the long-term fellow-up. However, the absence of a history of GT-CS independently predicts seizure remission in short- and long-term follow-up.

Conclusions: Surgery in PCEs proved to be effective in short- and long-term follow-up. Lesional posterior cortical epilepsy may be a progressive process in a substantial number of cases.

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Footnotes

  • Competing interests: None.

  • Ethics approval: Provided by the Clinical Ethics Committee in the Bethel Epilepsy Centre.

  • Patient consent: Obtained.

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