THE NATURAL HISTORY OF THE SURGICAL TREATMENT OF MEDICALLY REFRACTORY EXTRATEMPORAL EPILEPSIES DUE TO TAYLOR-TYPE FOCAL CORTICAL DYSPLASIA (MRETE/ TTFCD)
Abstract number :
3.242
Submission category :
Year :
2002
Submission ID :
345
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Andre Palmini, Frederick Andermann, Fran[ccedil]ois Dubeau, Eliseu Paglioli-Neto, Jaderson Costa da Costa, Hyoung-Ihl Kim, Andre Olivier, Eduardo Paglioli, Ligia Coutinho, Eva Andermann, Mirna Portuguez, Victor Martinez, Sergio Raupp, Jo[atilde]o-Rubi[ati
RATIONALE: The major determinants of surgical success and particularly the long-term outcome of patients with MRETE/TTFCD are still unclear.
OBJECTIVES: To correlate variable surgical strategies with both short-term (year 1) and long-term outcome (1-14 years later; mean 5.7; SD 3.5) in patients with MRETE/TTFCD. In addition, to analyze the post-operative evolution of these patients in terms of stability of surgical results over time.
METHODS: Patients and Methods: Fifty-six consecutive patients with MRETE/TTFCD who presented for evaluation and surgery from 2 to 38 years of age (mean 17.05; SD 8.4) were included. They all had (1) bona fide MRI and/or histopathological features characteristic of TTFCD; (2) ETE; (3) at least 3 years of overall post-operative follow up (mean 8.4; SD 4.0) and (4) specific outcome analysis at 1 year post-op, and at the last visit (or before reoperation), 1 to 14 years later. The impact of several surgical strategies on both short and long-term outcome was studied, taking into account the feasibility of complete resection of the lesion and of the cortex displaying epileptogenic discharges. Finally, the results obtained with reoperations in a subset of patients with unfavorable evolution were analyzed.
RESULTS: At year 1, 23 patients (41 %) were seizure-free (class A), and overall 32 (57%) were seizure free or greatly improved (A+B). In contrast, only 17 patients (30%) were in class A, and overall 21 (38%) demonstrated significant improvement (A+B) in the long-term (short-term vs long-term outcome p=0.07). Completeness of resection of the lesion, and of the cortical regions displaying electrocorticographic abnormalities (continuous and discontinuous) correlated significantly with the degree of seizure control in both the short and the long-term (all p[lt]0.00), as well with a stable satisfactory postoperative course (n= 18; 32%), as opposed to a running up1 (recurrence) of seizures (n=15; 27%) (all p[lt]0.00). On the basis of seizure recurrence or unsatisfactory results from the beginning, 21 patients (38%) were reoperated. Of 19 with at least 1 year post-op follow up (mean 4.2; SD 1.7), 5 were rendered seizure free, and overall 11 (52%) have improved greatly (classes A+B).
CONCLUSIONS: Short and long-term surgical outcomes differ with a trend toward statistical significance in patients with MRETE/TTFCD. Since 'running up' of seizures is common with incomplete resections of the epileptogenic zone, reoperations have a definite role in the management of these difficult cases.
[Supported by: FAPERGS]