Prognostic factors for the surgery for mesial temporal lobe epilepsy: longitudinal analysis

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Jeong, Sang-Wuk; Lee, Sang Kun; Hong, Keun-Sik; Kim, Kwang-Ki; Chung, Chun-Kee; Kim, Ho
Issue Date
Epilepsia. 2005 Aug;46(8):1273-9.
AdolescentAdultAge Factors*Anterior Temporal LobectomyAtrophyChildDisease-Free SurvivalEpilepsy, Temporal Lobe/diagnosis/*surgeryEpilepsy, Tonic-Clonic/diagnosis/surgeryFemaleFollow-Up StudiesFunctional LateralityHippocampus/pathologyHumansLogistic ModelsLongitudinal StudiesMagnetic Resonance Imaging/statistics & numerical dataMaleMiddle AgedModels, StatisticalMultivariate AnalysisPreoperative CarePrognosisSclerosis/pathologyTreatment Outcome
PURPOSE: Determining long-term prognostic factors of surgery for mesial temporal lobe epilepsy (MTLE) is important for identifying ideal candidates and predicting the prognosis for individual patients. We tried to identify the prognostic factors of anterior temporal lobectomy (ATL) for MTLE with longitudinal multivariate analysis. METHODS: Two hundred twenty-seven patients with MTLE were included in this study. The primary outcome variable was patient status 1-5 years after surgery: seizure free, or not. Clinical characteristics and recent diagnostic modalities were considered as prognostic factors. Univariate and standard multiple logistic-regression analysis for outcome at 1 and 5 years after surgery and the generalized estimation equation (GEE) model for longitudinal multiple logistic regression of the 5-year follow-up period were used. RESULTS: The seizure-free rate at 1 year was 81.1% and decreased to 75.2% at 5 years after surgery. By the univariate or standard multiple logistic-regression analysis, age at surgery or hippocampal sclerosis on magnetic resonance imaging (MRI) ipsilateral to surgery was significant for the postsurgical outcome. However, the longitudinal analysis by the GEE model revealed that younger age at surgery [odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43-0.81], absence of secondarily generalized tonic-clonic seizure (2 degrees GTCS; OR, 0.45; 95% CI, 0.26-0.79), and hippocampal sclerosis on MRI (OR, 2.44; 95% CI, 1.11-5.26) were significant predictors of a good surgical outcome. CONCLUSIONS: Age at surgery, presence of 2 degrees GTCS, and hippocampal sclerosis on MRI are independent prognostic factors for ATL in MTLE. These findings suggest that MTLE is a progressive disorder, and surgical outcome is better when early ATL is performed.
0013-9580 (Print)
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College of Medicine/School of Medicine (의과대학/대학원)Neurosurgery (신경외과학전공)Journal Papers (저널논문_신경외과학전공)
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