Prognostic factors determining poor postsurgical outcomes of mesial temporal lobe epilepsy

• Published in: PloS one 2018-10, Vol.13 (10), p.e0206095-e0206095
• Main Authors: Shin, Jong Hwa, Joo, Eun Yeon, Seo, Dae-Won, Shon, Young-Min, Hong, Seung Bong, Hong, Seung-Chyul
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age of Onset; Analysis; Biology and Life Sciences; Biomedical research; Brain - diagnostic imaging; Brain research; Child; Convulsions & seizures; Electroencephalography; Epilepsy; Epilepsy, Temporal Lobe - diagnostic imaging; Epilepsy, Temporal Lobe - surgery; Female; Hippocampus; Hospitals, University; Humans; Hypometabolism; Lesions; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medical prognosis; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Neurology; Neurosciences; Neurosurgery; Neurosurgical Procedures; NMR; Nuclear magnetic resonance; Odds Ratio; Outcome and process assessment (Medical care); Patients; Postoperative complications; Prognosis; Research and Analysis Methods; Retrospective Studies; Risk Factors; Sclerosis; Seizing; Seizures; Short term; Studies; Subgroups; Surgery; Surgical outcomes; Survival Analysis; Temporal lobe; Temporal lobe epilepsy; Treatment Outcome; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0206095

To investigate the long-term postoperative outcomes and predictive factors associated with poor surgical outcomes in mesial temporal lobe epilepsy (MTLE). We enrolled patients with MTLE who underwent resective surgery at single university-affiliated hospital. Surgical outcomes were determined using a modified Engel classification at the 2nd and 5th years after surgery and the last time of follow-up. The mean duration of follow-up after surgery was 7.6 ± 3.7 years (range, 5.0-21.0 years). 334 of 400 patients (83.5%) were seizure-free at the 5th postoperative year. Significant predictive factors of a poor outcome at the 5th year were a history of generalized tonic clonic (GTC) seizures (odds ratio, OR; 2.318), bi-temporal interictal epileptiform discharge (IED) (OR; 3.107), bilateral hippocampal sclerosis (HS) (OR; 5.471), unilateral HS and combined extra-hippocampal lesion (OR; 5.029), and bi-temporal hypometabolism (BTH) (OR; 4.438). Bi-temporal IED (hazard ratio, HR; 2.186), BTH (HR; 2.043), bilateral HS (HR; 2.541) and unilateral HS and combined extra-hippocampal lesion (HR; 2.75) were independently associated with seizure recurrence. We performed a subgroup analysis of 208 patients with unilateral HS, and their independent predictors of a poor outcome at the 5th year were BTH (OR; 5.838) and tailored hippocampal resection (OR; 11.053). This study demonstrates that 16.5% of MTLE patients had poor long-term outcomes after surgery. Bilateral involvement in electrophysiological and imaging studies predicts poor surgical outcomes in MTLE patients.