Seizure outcome after temporal lobectomy for temporal lobe epilepsy - A Kaplan-Meier survival analysis

Objective: To determine seizure outcome and its predictors in patients with medically refractory temporal lobe epilepsy (TLE) after temporal lobectomy (TL). Background: TL is the most common surgical procedure performed in ad olescents and adults for the treatment of medically refractory TLE. Seizure outcome has been reported extensively during the first few postoperative y ears, but little is known beyond that time. Methods: The authors analyzed s eizure outcome in 79 patients who underwent TL for epilepsy at the Duke Uni versity Medical Center from 1962 through 1984, Patients with less than 2 ye ars of follow-up and degenerative disorders were excluded. Predictors of se izure outcome were analyzed using Kaplan-Meier survival analyses. Results: The mean follow-up was 14 years (range, 2.1 to 33.6 years). Using Engel's c lassification, 65% of patients were class I, 15% were class II, 11% were cl ass III, and 9% were class IV. At least one postoperative seizure occurred in 55% of subjects. The majority of recurrences (86%) took place within 2 y ears of surgery. Later recurrences tended not to lead to medical intractabi lity. Higher monthly preoperative seizure frequency was associated with poo r seizure outcome. A seizure-free state at 2 years was found to be a better predictor of long-term outcome than the 6-, 12-, and 18-month landmarks. C onclusions: TL provides sustained, long-term benefit in patients with medic ally refractory TLE. Seizure-free status at 2 years from the time of surger y is predictive of long-term remission.