Epilepsy with Mesial Temporal Sclerosis: Which Characteristics of Clinical and Ancillary Exams May Influence Surgical Prognosis?
Abstract number :
2.207
Submission category :
Year :
2000
Submission ID :
2560
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Carmen L Jorge, Luis H M Castro, Kette D R Valente, Leticia P B Sampaio, Hung T Wen, Sueli K N Marie, Elza M T Yacubian, Univ of Sao Paulo, Sao Paulo, Brazil.
RATIONALE:To analyze the prognostic factors associated with a favorable surgical outcome (seizure control) in patients with refractory epilepsy secondary to mesial temporal sclerosis (MTS). METHODS:Fifty patients with MTS and a minimum post-surgery follow-up of one year were classified according to Engel's scale. Factors analyzed included: possible etiologic factors for MTS, clinical features, neuropsychological profile (NP) and extent of surgical resection (evaluated by post-operative MRI). RESULTS: Thirty-nine patients (78%) were classified as class I, and 11 (22%) as class II-IV of Engel. Factors not found to be associated to prognosis were: age of onset of epileptic seizures (ES), duration of epilepsy, age at time of clinical evaluation, possible etiological factors for MTS, global IQ, presence of lateralizing findings on NP, and side of the lesion defined by ictal and interictal EEG, MRI and SPECT. The group with worse outcome presented more commonly a family history of epilepsy (p=0.017), lack of a history of simple partial seizures(p=0.065), NP showing evidence of contralateral involvement (p=0.092) and presence of seizures in the post-surgical period similar to those observed during pre-surgical evaluation. Post-surgical MRI finding such as contralateral involvement and gliosis of the subinsular region was seen more frequently in the worse outcome group, not reaching statistical significance. The extension of the resection did not differ between both groups. Statistically significant association with unfavorable prognosis was found only with presence of epileptiform discharges on the post-surgical EEG (p<0.0001). Logistic regression analysis showed that family history (p=0.0069) and persistence of EEG discharges in the post-surgical EEG (p=0.0002) were the only significant factors. CONCLUSIONS:_Family history of epileptic seizures and persistent epileptiform activity on post-surgical EEG were the only factors associated to unfavorable outcome in a group of patients with MTS submitted to standard temporal lobectomy.