Abstracts

Objective: To demonstrate that the majority of a group of veterans who received care throught the VA system had satisfactory seizure outcome after anterior temporal lobectomy (ATL).
Epilepsy surgery is an effective therapy for patients with refractory epilepsy of temporal origin. The veteran population is biased toward older age of onset of epilepsy and other co-morbidities including substance use or other psychiatric diagnoses. We retrospectively studied the outcome of ATL among a population of veterans and evaluated outcome related to co-morbidities.
METHODS: The database at the Veterans Memorial Hospital, in Madison, WI was used to identify patients who underwent ATL for intractable epilepsy between 1990 and 2000. Chart review was conducted on all identified patients, who were contacted to review their clinical history and obtain their seizure history and vocational status. End points measured were post-operative seizure outcome, current quality of life using the QOLIE-31 questionnaire, and vocational status. Multiple regression analysis evaluated factors associated with outcome.
RESULTS: A total of 29 patients underwent ATL. Two of the patients died post surgically and therefore were not included in the study. The mean age at onset was 25 years ([plusminus]10.2). Mean duration of epilepsy prior to surgery was 16.5 years ([plusminus]8.9) and mean age at surgery was 43.8 ([plusminus]8.7). 15 patients underwent left ATL, and 12 right ATL. The pathological diagnoses were mesial temporal sclerosis with or without heterotopias (16), vascular malformations (3), contusion (1), infarct (1), and 6 patients had either normal hippocampus tissue or non-specific findings. Seven of the 27 (26%) had a pre-surgery history of a non-substance abuse psychiatric diagnosis (depression, post traumatic stress disorder, personality disorder, psychosis, or anxiety disorder). Eight of 27 (30%) had a history of substance abuse prior to surgery (3 of these 8 had an additional psychiatric diagnosis). Eighteen of the 27 (67%) had a good outcome (Engel[scquote]s Class I [56%] or Class II [11%]), and the remaining 9 patients (33%) had poor outcome (Class III or IV). There was no difference in the frequency of good outcome among the patients with a history of substance abuse (63%), other psychiatric diagnosis (71%), or no psychiatric diagnosis (67%). There were significant correlations between seizure outcome and quality of life score (rs = .67, p [lt] .001) and post-op vocational status (rs = .48, p = .01).
CONCLUSIONS: In this study of veterans who underwent ATL, seizure outcome was consistent with that reported in the literature for the general population. Although the sample size was small, the data suggest that post-ATL seizure outcome can be satisfactory among veterans even in the context of the late mean age of epilepsy onset and the psychiatric diagnoses that were present in this sample.