Document Detail


Latency to first seizure after temporal lobectomy predicts long-term outcome.
MedLine Citation:
PMID:  21069902     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Temporal lobectomy is a well-established treatment for refractory temporal lobe epilepsy, yet many patients experience at least one seizure postoperatively. Little is known about the prognostic significance of the time from surgery to first seizure relapse in predicting long-term outcome.
METHODS: In a retrospective analysis of patients who reported at least one complex partial seizure (CPS) or generalized tonic–clonic seizure (GTCS) after anterior temporal lobectomy (n = 268), we used a nominal response logistic model to predict the odds ratio (OR) of a seizure outcome based on length of the latency period from surgery to first postoperative seizure. A modified Engel outcome class scheme was used. We controlled for factors known to influence postoperative outcome, including history of tonic–clonic seizures, intelligence quotient (IQ), preoperative seizure frequency, magnetic resonance imaging (MRI) findings, and history of febrile convulsions.
RESULTS: In the univariate analysis, the latency from surgery to the first postoperative disabling seizure was significantly associated with long-term outcome. Longer latency was associated with higher odds of being seizure-free or improved (modified Engel's classes 1, 2, and 3) relative to the unimproved state (class 4) (p < 0.001, 0.001 and 0.004, respectively). Conversely, a shorter latency increased the likelihood of achieving the worst prognosis (class 4) relative to class 1 (p < 0.001). Multivariate analysis yielded similar results.
DISCUSSION: Latency to the first postoperative seizure predicts long-term outcome, with short latencies portending poor prognosis and long latencies portending a good prognosis. This information can be used for patient counseling and may influence decisions regarding reoperation.
Authors:
Sarah E Buckingham; Inna Chervoneva; Ashwini Sharan; Andro Zangaladze; Scott Mintzer; Christopher Skidmore; Maromi Nei; James Evans; Edward Pequignot; Michael R Sperling
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Epilepsia     Volume:  51     ISSN:  1528-1167     ISO Abbreviation:  Epilepsia     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-11-10     Completed Date:  2010-12-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1987-93     Citation Subset:  IM    
Affiliation:
Jefferson Medical College, Philadelphia, Pennsylvania, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anterior Temporal Lobectomy / methods*
Disease-Free Survival
Epilepsy, Temporal Lobe / diagnosis,  surgery*
Female
Follow-Up Studies
Humans
Logistic Models
Male
Outcome Assessment (Health Care) / statistics & numerical data
Postoperative Complications / epidemiology
Probability
Prognosis
Recurrence
Remission Induction
Research Design
Retrospective Studies
Seizures / epidemiology
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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