Abstracts

RATIONALE: Epilepsy surgery outcomes have not been previously reported from military institutions. The current study was performed to determine the seizure outcome, quality of life outcome, and predictors of seizure outcome in patients undergoing temporal lobectomy for refractory epilepsy at Walter Reed Army Medical Center, the only U.S. military medical center with a comprehensive epilepsy surgery program.
At the end of this activity participants should understand the outcomes of epilepsy surgery in the U.S. military.
METHODS: Eighty-one of 84 consecutive patients treated with anterior temporal lobectomy at Walter Reed Army Medical Center between 1986 and 2000 were followed for a minimum of 1 year and a mean of 4 years. Outcome measures included seizure frequency according to the Engel classification system, driving, employment, and use of anticonvulsant medications. The association between seizure outcome and the results of pre-operative EEG, MRI, SPECT, and surgical pathology was assessed by univariate analysis.
RESULTS: Following temporal lobectomy, 90% of patients had improvement in seizures (Engel class 1, 2, or 3) and 70% of patients had remission of seizures (Engel class 1). The driving rate increased from 2.5% to 60% (p[lt]0.0001), the employment rate increased from 35% to 62% (p[lt]0.017), and anticonvulsant use decreased from 2.03 AEDs per patient to 1.26 AEDs per patient (p[lt]0.0001). Five of ten (50%) patients serving on active duty in the military at the time of surgery achieved complete seizure remission post-operatively and continued to serve in the armed forces. Complications occured in 6% of patients and included hemiparesis, dysphasia, and memory impairment. Interictal epileptiform discharges confined to the ipsilateral temporal lobe, neuroimaging abnormalities in the ipsilateral temporal lobe, and mesial temporal sclerosis on pathology were each associated with post-operative seizure remission. Bilateral interictal EEG abnormalities and normal pathology were associated with a less favorable seizure outcome.
CONCLUSIONS: Temporal lobectomy for refractory epilepsy produces seizure remission and improves quality of life in most patients who undergo this procedure in the U.S. military. The outcomes are similar to those reported from non-military institutions. Seizure remission after temporal lobectomy enables some active duty military personnel to continue serving in the armed forces.
[Supported by: U.S. Army]