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Factors predicting the outcome following surgical treatment of mesial temporal epilepsy due to mesial temporal sclerosis

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Abstract

Background

Mesial temporal sclerosis (MTS) is the most common disease found in an epilepsy surgery series. Early age of onset, a history of febrile convulsions, epileptiform discharges on EEG, duration of epilepsy, number of generalized seizures and severity of psychiatric disorders are possible prognostic factors in patients with MTS.

Objective

The aim of this study is to review the clinical, semiotic, psychological, electrophysiological and neuroradiological researches and relate their findings to the prognosis of patients with MTS who underwent anteromedial temporal lobectomy (ATL).

Methods

Of 1,214 patients evaluated for surgery in the epilepsy Center of Faculdade de Medicina de São Jose do Rio Preto (FAMERP), a tertiary Brazilian epilepsy center, 400 underwent ATL for MTS. Examinations and clinical data were analyzed and compared with the Engel Outcome Classification.

Results

Of all the items analyzed, the MRI showed the greatest influence on patient outcome. As for the clinical evaluation and pathological antecedents, age at surgery, epilepsy duration, perinatal insults, family history of epilepsy, febrile seizures, neuropsychological abnormalities and presence of generalized tonic-clonic seizure all had statistical significance.

Conclusion

In order to identify the most appropriate candidates for ATL, it is very important to consider the prognostic factors associated with a favorable outcome for counseling patients in daily practice.

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Authors and Affiliations

  1. Neurosurgery. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil

    Rodrigo Antonio Rocha da Cruz Adry, Lucas Crociati Meguins & Sebastião Carlos da Silva Júnior

  2. Hospital Aliança, Salvador, Bahia, Brazil

    Rodrigo Antonio Rocha da Cruz Adry

  3. Federal University of Sergipe at Aracaju, Aracaju, Sergipe, Brazil

    Carlos Umberto Pereira

  4. Psychiatry. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil

    Gerardo Maria de Araújo Filho

  5. Neurology. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil

    Lúcia Helena Neves Marques

Authors
  1. Rodrigo Antonio Rocha da Cruz Adry
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  2. Lucas Crociati Meguins
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  3. Sebastião Carlos da Silva Júnior
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  4. Carlos Umberto Pereira
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  5. Gerardo Maria de Araújo Filho
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  6. Lúcia Helena Neves Marques
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Corresponding author

Correspondence to Rodrigo Antonio Rocha da Cruz Adry.

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Funding

No funding was received for this research.

Conflict of Interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Comments

The authors present a large cohort of patients with MTLS, 400 out of 1214 patients evaluated for epilepsy surgery in the epilepsy center of Faculdade de Medicina de São Jose do Rio Preto. In their setting they have followed patients from several states of Brazil. My view is that the strength of this report is the large cohort operated on at one center, and it has taken a substantial effort to collect the data. They found the most important prognostic factor in their cohort to be the MRI finding, which is not surprising, but also factors such as age at surgery, epilepsy duration, seizure frequency, perinatal insults and other factors. They have an impressively low number of major complications, 6 out of 400, and they report separately findings of quadrantanopia, which of course is not regarded as an unexpected complication. Even if the results and conclusions of this report are not different from what we regard as important in the treatment of mesial temporal lobe sclerosis, it is still a confirmation in a large cohort of patients, and I recommend reading it.

Bertil Rydenhag

Gothenburg, Sweden

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Adry, R.A.R.d.C., Meguins, L.C., da Silva Júnior, S.C. et al. Factors predicting the outcome following surgical treatment of mesial temporal epilepsy due to mesial temporal sclerosis. Acta Neurochir 158, 2355–2363 (2016). https://doi.org/10.1007/s00701-016-2992-0

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  • DOI: https://doi.org/10.1007/s00701-016-2992-0

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