Clinical Article

Acta Neurochirurgica

, Volume 154, Issue 8, pp 1327-1336

Seizure outcome 1 year after temporal lobe epilepsy: an analysis of MR volumetric and clinical parameters

  • Christian-Andreas MuellerAffiliated withDepartment of Neurosurgery, University of BonnUniversity of BonnDepartment of Neurosurgery, University Hospital of the Aachen University (RWTH) Email author 
  • , Jasmin ScorzinAffiliated withDepartment of Neurosurgery, University of BonnUniversity of Bonn
  • , Marec von LeheAffiliated withDepartment of Neurosurgery, University of BonnUniversity of Bonn
  • , Rolf FimmersAffiliated withUniversity of BonnInstitute of Medical Biometry, Informatics and Epidemiology, University of Bonn
  • , Christoph HelmstaedterAffiliated withUniversity of BonnDepartment of Epileptology, University of Bonn
  • , Josef ZentnerAffiliated withUniversity of BonnDepartment of Neurosurgery, University of Freiburg
  • , Thomas-Nicolas LehmannAffiliated withUniversity of BonnDepartment of Neurosurgery, Helios-Klinikum Bad Saarow
  • , Heinz-Joachim MeenckeAffiliated withUniversity of BonnDepartment of Epileptology, Epilepsiezentrum Berlin Brandenburg and von Bodelschwingsche Anstalten, Königin Elisabeth Hospital Herzberge
  • , Andreas Schulze-BonhageAffiliated withUniversity of BonnEpilepsy Center, University Hospital of Freiburg, Freiburg i.Br.
    • , Johannes SchrammAffiliated withDepartment of Neurosurgery, University of BonnUniversity of Bonn

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Abstract

Background

The aim of this work was to determine predictors that may contribute to surgical success or failure. Relevant pre- and postoperative baseline data were analyzed, and temporal structures underwent a volumetric analysis.

Methods

A total of 207 patients (107 female) underwent complete evaluation for epilepsy surgery. Prospectively collected data used for this analysis included the clinical and demographic data. Classic prognostic factors (e.g., gender, age at operation, age at epilepsy manifestation, duration of epilepsy, education, side of pathology, intracranial EEG recordings, secondarily generalized tonic-clonic seizures, etiological factors, histology) and a volumetric analysis of 12 temporal lobe subregions were used in a regression analysis to identify possible prognostic factors in surgery for TLE. Primary outcome measure was seizure freedom at 1 year and during the full first year expressed as class I in the ILAE outcome scale.

Results

In the univariate analysis, we identified one negative predictor for a less favorable seizure outcome: intracranial EEG recordings (p = 0.010), hippocampal sclerosis as histological finding trended toward statistical significance (p = 0.054). No statistical outcome significance was found for preoperative temporal lobe compartment volume loss or postoperative lateral atrophy after mesial resection.

Conclusions

Necessity for intracranial EEG recording is an independent factor of not optimal seizure control in the 1-year follow-up. Preoperative temporal lobe volume differences including smaller mesial subcompartments did not correlate with poorer seizure outcome.

Keywords

Temporal lobe epilepsy Epilepsy surgery Outcome Predictors Volumetric MRI use in epilepsy