Long-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients Clinical article

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dc.contributor.authorElsharkawy, Alaa Eldin
dc.contributor.authorAlabbasi, Abdel Hamid
dc.contributor.authorPannek, Heinz
dc.contributor.authorOppel, Falk
dc.contributor.authorSchulz, Reinhard
dc.contributor.authorHoppe, Mathias
dc.contributor.authorHamad, Ana Paula [UNIFESP]
dc.contributor.authorNayel, Mohamed
dc.contributor.authorIssa, Ahmed
dc.contributor.authorEbner, Alois
dc.contributor.institutionBethel Epilepsy Ctr
dc.contributor.institutionCairo Univ
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionKrankenhaus Mara
dc.date.accessioned2016-01-24T13:52:38Z
dc.date.available2016-01-24T13:52:38Z
dc.date.issued2009-06-01
dc.description.abstractObject. the aim of this study was to evaluate the long-term efficacy of temporal lobe epilepsy (TLE) Surgery and potential risk factors for seizure recurrence after surgery.Methods. This retrospective study included 434 consecutive adult patients who underwent TLE surgery at Bethel Epilepsy Centre between 1991 and 2002.Results. Hippocampal sclerosis was found in 62% of patients, gliosis in 17.3%, tumors in 20%, and focal cortical dysplasia (FCD) in 6.9%. Based on a Kaplan-Meier analysis, the probability of Engel Class I outcome for the patients overall was 76.2% (95% CI 71-81%) at 6 months, 72.3% (95% CI 68-76%) at 2 years, 71.1% (95% CI 67-75%) at 5 years, 70.8% (95% CI 65-75%) at 10 years, and 69.4% (95% CI 64-74%) at 16 years postoperatively. the likelihood of remaining seizure free after 2 years of freedom from seizures was 90% (95% CI 82-98%) for 16 years. Seizure relapse Occurred in all subgroups. Patients with FCD had the highest risk of recurrence (hazard ratio 2.15, 95% CI 0.849-5.545). Predictors of remission were the presence of hippocampal atrophy on preoperative MR imaging and a family history of epilepsy. Predictors of relapse were the presence of bilateral interictal sharp waves and versive seizures. Six-month follow-up electroencephalography predicted relapse in patients with FCD. Short epilepsy duration was predictive of seizure remission in patients with tumors and gliosis; 28.1% of patients were able to discontinue antiepileptic medications without an increased risk of seizure recurrence (hazard ratio 1.05, 95% CI 0.933-1.20).Conclusions. These findings highlight the role of etiology in prediction of long-term Outcome after TLE surgery. (DOI: 10.3171/2008.6.JNS17613)en
dc.description.affiliationBethel Epilepsy Ctr, Dept Neurosurg, Bielefeld, Germany
dc.description.affiliationCairo Univ, Inst Stat Studies & Res, Dept Biostat & Demog, Cairo, Egypt
dc.description.affiliationCairo Univ, Inst Stat Studies & Res, Dept Neurosurg, Cairo, Egypt
dc.description.affiliationUniversidade Federal de São Paulo, São Paulo, Brazil
dc.description.affiliationKrankenhaus Mara, Bethel Epilepsy Ctr, Dept Presurg Evaluat, D-33617 Bielefeld, Germany
dc.description.affiliationUnifespUniversidade Federal de São Paulo, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent1135-1146
dc.identifierhttp://dx.doi.org/10.3171/2008.6.JNS17613
dc.identifier.citationJournal of Neurosurgery. Rolling Meadows: Amer Assoc Neurological Surgeons, v. 110, n. 6, p. 1135-1146, 2009.
dc.identifier.doi10.3171/2008.6.JNS17613
dc.identifier.issn0022-3085
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/31594
dc.identifier.wosWOS:000266460800004
dc.language.isoeng
dc.publisherAmer Assoc Neurological Surgeons
dc.relation.ispartofJournal of Neurosurgery
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectepilepsy surgeryen
dc.subjectfocal cortical dysplasiaen
dc.subjectgliosisen
dc.subjecthippocampal sclerosisen
dc.subjectlong-term outcomeen
dc.subjecttemporal lobeen
dc.titleLong-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients Clinical articleen
dc.typeinfo:eu-repo/semantics/article
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