Abstracts

Predictors of outcome after temporal lobectomy for mesial temporal lobe epilepsy (MTLE) remain controversial. In particular, family history (FH) of epilepsy as a prognostic factor has not been studied extensively. Our objective is to determine if FH predicts histopathological characteristics and outcome following temporal lobectomy. Included were 186 consecutive patients who had resective epilepsy surgery for MTLE at a single tertiary center between 1990 and 2002. Retrospective review of medical records was performed for data on febrile seizure (FS), complex febrile seizure (cFS), major head trauma, and intracranial infection. Pedigree analysis was conducted by patient and family interview using a validated questionnaire for clinical seizure diagnosis. Outcome was determined by follow-up clinical interview using Engel[rsquo]s classification. Neuronal counts and immunohistochemistry were performed on the surgical tissue, and specimens were divided into the following subgroups: classical mesial temporal lobe epilepsy (MTLE), MTLE without evidence of dynorphin staining in the inner molecular layer (MTLE/DYN-), cell loss only in the CA1 region (CA1), mass lesions (MaTLE), or no visual evidence of sclerosis or immunohistochemical reorganization (paradoxical or PTLE). The 186 patients were 54% female and 22% had a history of simple FS, 20% of cFS, 10% of head trauma, and 14% of central nervous system infection. Positive FH was identified in 59 patients (32%), 16 with a first degree relative, 24 with a second degree relative and 19 with a third degree relative. Presence or absence of FH was not significantly related to surgical outcome ([italic]p[/italic]=0.95, OR=1.02), nor was FH of a first degree relative with epilepsy ([italic]p[/italic]=0.87, OR =0.91), or two or more relatives with epilepsy ([italic]p[/italic]=0.42, OR=0.63). FH of FS was present in 14 patients (8%). Presence or absence of FH of FS was not significantly related to surgical outcome ([italic]p[/italic]=0.77, OR=1.21). Pathology was available for 105 patients: 62 were MTLE, 9 were MTLE/DYN-, 9 were CA1, 7 were PTLE, and 16 were MaTLE. The Pearson Chi-Square test did not reveal a significant relationship of pathology with FH of epilepsy ([italic]p[/italic]=0.75) or FH of FS ([italic]p[/italic]=0.21). FH of epilepsy or FS was not predictive of surgical outcome or pathology. Genetic influences on MTLE are heterogeneous and likely have a variable influence on these measures. Characterization of seizure type in relatives may be necessary. Further definition of the relationship between FH, pathology, and surgical outcome could provide a useful tool for counseling epilepsy surgical candidates. (Supported by The Epilepsy Foundation of America)