V. Salanova et al., Longitudinal follow-up in 145 patients with medically refractory temporal lobe epilepsy treated surgically between 1984 and 1995, EPILEPSIA, 40(10), 1999, pp. 1417-1423
Purpose: There are few studies of prolonged longitudinal follow-up after te
mporal resections.
Methods: We analyzed 145 consecutive patients with temporal lobe epilepsy t
reated surgically. Patients had a comprehensive presurgical evaluation, inc
luding video-EEG, psychometric testing, magnetic resonance imaging (MRI), s
ingle photon emission computed tomography (SPECT), intracarotid amobarbital
procedure (IAP), and recently, volumetric head MRIs and F-fluorodeoxygluco
se-position emission tomography (FDC-PET) scans. Most had en bloc temporal
resections, and a few had lesionectomies and resection of the epileptogenic
zone. There was no surgical mortality. Longitudinal follow-up data of the
seizure outcome were analyzed by actuarial analysis. Patients were followed
up at 6 weeks, 3 months, 6 months, and then on a yearly basis. The mean fo
llow-up was 5.6 years.
Results: Sixty-six percent were seizure free at 1 year, 63% at 2 years, 60%
at 5 years, and 55% at 10 years follow-up. Moreover, 85%, became seizure f
ree for greater than or equal to 2 at the time of last follow-up or had rar
e seizures. Patients who were seizure free for 1 and 2 years after surgery,
had an 83% and 92% probability, respectively, of remaining seizure free at
the time of last follow-up. Ninety-one percent of patients with small tumo
rs and cavernous angiomas became seizure free compared with 69% of patients
with hippocampal sclerosis.
Conclusions: Actuarial analysis showed that the long-term surgical outcome
of temporal lobe epilepsy remains favorable. Follow-up at 1 and 2 years is
highly predictive of the long-term outcome. Patients with discrete lesions
had the best outcome. Most of the patients with late recurrences had hippoc
ampal sclerosis or temporal lobe gliosis. Some patients with postoperative
seizures eventually became seizure free, reflecting the running-down phenom
enon.