Authors :
Presenting Author: Ming-Chen Tsai, MD – Tri-Service General Hospital, National Defense Medical University
Keith Starnes, MD – Mayo Clinic, Rochester MN, USA.
Anthony Fine, MD – Mayo Clinic
Katherine Nickels, MD – Mayo Clinic, Rochester MN, USA.
Elaine Wirrell, MD – Mayo Clinic, Rochester MN, USA.
Jamie J Van Gompel, MD – Mayo Clinic, Rochester MN, USA.
Kai Miller, MD, PhD – Mayo Clinic
William S Harmsen, MS – Mayo Clinic, Rochester MN, USA.
Lily C. Wong-Kisiel, MD – Mayo Clinic, Rochester, MN, USA.
Rationale:
A substantial proportion of patients experience seizure recurrence following temporal lobe epilepsy (TLE) surgery. This study aimed to identify predictors of recurrence and characterize recurrence patterns, treatment response, and long-term outcomes using a 16-year longitudinal surgical database.
Methods:
We retrospectively reviewed 61 children and adolescents (0-19 years) with TLE who underwent resective/destructive temporal lobe surgery at Mayo Clinic, Rochester (2008-2024). Patients with prior epilepsy surgery, < 1-year follow-up, or without medical record authorization were excluded. Data were analyzed using descriptive statistics, survival analysis, and Cox proportional hazard models. To identify predictive factors for seizure recurrence, we applied univariate Cox proportional hazards models to assess the associations of clinical variables with recurrence risk. Variables with a univariate p-value < 0.10 were selected for a multivariate Cox regression model, with statistical significance defined as p < 0.05. Seizure recurrence was classified as: acute post-operative seizures (APOS): within 1 week post-surgery; early recurrence: > 1 week-2 years post-surgery; late recurrence: > 2 years post-surgery. Delayed seizure freedom was defined as ≥ 1 year seizure-free prior to last follow-up after initial recurrence.
Results:
Patient characteristics were summarized in Table 1. Thirty-four (55.7%) patients experienced seizure recurrence over a mean follow-up of 63 months (range 12-173). Median time to recurrence was 4 years. Four patients (6.5%) had APOS; all developed early recurrence. Multivariate analysis revealed APOS (HR = 5.17, 95% CI = 1.43-18.66, p =0.012) as a predictive factor for recurrence. Figure 1 demonstrates seizure recurrences, possible causes of surgical failure, and long-term outcomes of the patients. Delayed seizure freedom was achieved with medication trials in 19% (5/26) of early and 75% (6/8) of late recurrences. Repeat surgery resulted in seizure freedom in 36 % (4/11) of early recurrences. At last follow-up, 68% (42/61) were seizure free: 44% (27/61) since first surgery and 24% (15/61) after recurrence. Antiseizure medication was withdrawn in 24.5% (15/61) patients.
Conclusions:
TLE surgery offers sustained seizure control in two-thirds of pediatric and adolescent patients, but recurrence is not uncommon. APOS is a key predictor of recurrence and warrants closer monitoring and timely intervention. Early recurrence is less likely to be medically responsive, and timely repeat surgical intervention should be considered.
Funding: None.