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Long-term outcome of lesional posterior cortical epilepsy surgery in adults
  1. Alaa Eldin Elsharkawy (alaa.elsharkawy{at}mara.de)
  1. Department of Presurgical Evaluation, Bethel Epilepsy Centre, Germany
    1. Nasser M F El-Ghandour (elghandour{at}yahoo.com)
    1. Neurosurgical Department, Cairo University, Cairo, Egypt
      1. Heinz Pannek
      1. Neurosurgical Department, Bethel Epilepsy Centre, Germany
        1. Falk Oppel (falk.oppel{at}evkb.de)
        1. Neurosurgical Department, Bethel Epilepsy Centre, Germany
          1. Friedrich G Woermann (friedrich.woermann{at}mara.de)
          1. MRI Unit, Bethel Epilepsy Centre, Germany
            1. Mohamed Nayel
            1. Neurosurgical Department, Cairo University, Cairo, Egypt
              1. Matthias Hoppe
              1. Department of Presurgical Evaluation, Bethel Epilepsy Centre, Germany
                1. Reinhard Schulz
                1. Department of Presurgical Evaluation, Bethel Epilepsy Centre, Germany
                  1. Ahmed Issa
                  1. Neurosurgical Department, Cairo University, Cairo, Egypt
                    1. Alois Ebner (alois.ebner{at}mara.de)
                    1. Department of Presurgical Evaluation, Bethel Epilepsy Centre, Germany

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

                      Results: The probability of remaining in Engel Class I was 66.3% (95% CI 60-72) at 6 months, 52.5% (95% CI 47–57) at 2 years, 52.9% (CI 45–59) at 5 years, and 47.1% (CI 42–52) at 10 years. Factors predicting poor outcome were the presence of a somatosensory aura, extra-regional spikes, incomplete resection, interictal epileptiform discharge (IED) in EEG 6 months and 2 years postsurgery, history of generalized 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 long and short term as fellows: incomplete resection as proven by postoperative MRI (HR 2.059 (CI 1.195-3.673) 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 -4.734) predicts seizure relapse in the long-term follow-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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