Clinical characteristics and predictive factors in 98 patients with complex partial seizures treated with temporal resection
V. Salanova, O. N. Markand and R. Worth
Department of Neurology, Indiana University School of Medicine, Indianapolis.
OBJECTIVE: To analyze the preoperative and operative factors predictive of
outcome in patients undergoing surgery for temporal lobe epilepsy. DESIGN:
From 1984 to 1992, 98 patients with medically refractory temporal lobe
epilepsy underwent surgery. Evaluation included the following: video
electroencephalography (13 patients had intracranial recordings), head
magnetic resonance imaging, interictal and ictal single photon emission
computed tomography, psychometric testing, and Wada testing. Seizure-free
groups and non-seizure-free groups were analyzed. Follow-up of 1 year to 8
years was available for 89 patients (mean, 3.2 years). SETTING: Indiana
University Epilepsy Surgery Program, Indianapolis. OUTCOME: Sixty percent
(53/89) were seizure free, 16% (14/89) had rare seizures, 13% (12/89) had
worthwhile improvement, and 11% (10/89) showed no improvement. Forty-two
percent of seizure-free patients had a history of febrile seizures compared
with 5% of non-seizure-free patients. Ictal single photon emission computed
tomography showed increased flow on the side of seizure onset in 86% of
seizure-free patients compared with 62% of non-seizure-free patients.
Ninety-seven percent of seizure-free patients had a pathologic diagnosis;
mesial temporal structures were identified in 61%. Only 64% of
non-seizure-free patients had a pathologic diagnosis, and mesial temporal
structures were identified in only 36% of non-seizure-free patients.
CONCLUSIONS: Eighty-nine percent (79/89) of our patients benefited from
surgery. The following factors were predictive of good outcome: a history
of febrile seizures; ictal single photon emission computed tomography
showing increased blood flow ipsilateral to the epileptogenic zone; a
pathologic diagnosis; and the presence of mesial temporal structures in the
resected tissue.
