Abstracts

Following an antero-temporal lobectomy, one third to one half of patients who become free of any disabling seizures continue experiencing auras. The cause of temporal lobe epilepsy (TLE), duration of the seizure disorder and the presence of generalized tonic-clonic (GTC) seizures have been identified as predictors of post-surgical outcome folloiwng a temporal lobectomy. A comorbid psychiatric history has also been associated with a worse post-surgical seizure outcome in these patients. Predictors of persistence of post-surgical auras in patients free of disabling seizures are yet to be identified., 97 consecutive patients, 58 men and 39 women with a mean age of 30.6[plusmn]10.7 years who underwent an antero-temporal lobectomy at the Rush Epilepsy Center were included in the study. The cause of TLE was: mesial temporal sclerosis in 60 (62%), lesional TLE in 18 (18.5%) and idiopathic TLE in 19 (19.5%). The mean duration of the seizure disorder was 19.7[plusmn]8.8 years. All patients had undergone a psychiatric evaluation as part of their presurgical evaluation ([italic]not[/italic] out of suspicion of psychiatric disorder). All patients had to have a minimal post-surgical follow-up period of 2 years before being included in the study (mean post-surgical follow-up: 6.9[plusmn]3.0 years).
The folloiwng variables were entered into a logistic regression model to identify the predictors of achieving a seizure-free state without auras: cause of TLE, duration of seizure disorder, occurrence of GTC seizures and life-time history of depression., Among the 97 patients, 37 (38%) were free of any disabling seizures [italic]and [/italic]auras since the time of surgery (Class IA of Engel). An additional 43 patients (44.3%) were free of disabling seizures but had auras (Class I-B). A life time prevalence of depression of 48.5% (n = 47) was identified among the 97 patients. The [italic]absence[/italic] of a life-time history of depression was the [italic]only [/italic]variable that predicted the achievemnet of a seizure-free outcome [italic]without auras[/italic] (p[lt]0.0001). This model correctly classified 76% the data. A lifetime history of depression continued to be a predictor, but to a lesser degree when the post-surgical outcomes consisted of freedom of disabling seizures [italic]with or without[/italic] auras (p = 0.001) and freedom of disabling seizures in the last two years (p = 0.06). On the other hand the cause of TLE became a predictor in the setting of these two outcomes (p = 0.04 and p = 0.009, respectively)., A presurgical history of depression appears to predict the peristence of auras after an antero-temporal lobectomy in patients that become free of diabling seizures. The pathogenic mechanisms that mediate thsi phenomenon are yet to be identified.,