Latency to first seizure after temporal lobectomy predicts long-term outcome

被引:21
作者
Buckingham, Sarah E. [2 ]
Chervoneva, Inna [3 ]
Sharan, Ashwini [1 ,4 ]
Zangaladze, Andro [1 ,5 ]
Mintzer, Scott [1 ,5 ]
Skidmore, Christopher [1 ,5 ]
Nei, Maromi [1 ,5 ]
Evans, James [1 ,4 ]
Pequignot, Edward [3 ]
Sperling, Michael R. [1 ,5 ]
机构
[1] Thomas Jefferson Univ, Jefferson Comprehens Epilepsy Ctr, Philadelphia, PA 19107 USA
[2] Jefferson Med Coll, Philadelphia, PA USA
[3] Thomas Jefferson Univ, Dept Pharmacol & Expt Therapeut, Philadelphia, PA 19107 USA
[4] Jefferson Med Coll, Dept Neurosurg, Philadelphia, PA USA
[5] Thomas Jefferson Univ, Jefferson Med Coll, Dept Neurol, Philadelphia, PA 19107 USA
关键词
Temporal lobe epilepsy; Epilepsy surgery; Seizure recurrence; Seizure remission; RESECTIVE EPILEPSY SURGERY; LOBE EPILEPSY; FOLLOW-UP; INTRACTABLE EPILEPSY; ANTIEPILEPTIC DRUGS; FAILED SURGERY; RECURRENCE; EEG; REMISSION;
D O I
10.1111/j.1528-1167.2010.02721.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
P>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.
引用
收藏
页码:1987 / 1993
页数:7
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