Seizure outcomes and associated factors in adults with unilateral mesial temporal lobe epilepsy undergoing surgery.

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie Pub Date : 2024-12-05 DOI:10.1016/j.neuchi.2024.101622

Mariana Torres-Bustamante, Manuel Vicente Jaramillo-Canastero, José Fernando Zapata-Berruecos, Julián Carvajal-Castrillón, Lucas Lozano-García, Juan Felipe Álvarez, Héctor Jaramillo-Betancur

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引用次数: 0

Abstract

Objective: To analyze postoperative seizure outcomes and factors associated with unfavorable seizure control (Engel III-IV) in adults with drug-resistant unilateral mesial temporal epilepsy who underwent temporal lobectomy.

Methods: This was an observational, longitudinal, and retrospective study. A descriptive analysis of sociodemographic, clinical, and paraclinical characteristics was performed. The incidence rate of inadequate seizure control was calculated, and a Kaplan-Meier curve was reported. Cox regression analysis was conducted to identify factors associated with unfavorable outcomes.

Results: A total of 285 patients were included, 56.4% were women, and 49.12% underwent standard temporal lobectomy. Engel I were achieved in 70.87% of patients, while 6.31% experienced postsurgical complications. The estimated incidence rate of unfavorable outcomes was 3.87 cases per 100 person-years (95% CI: 3.51-4.27). Cox regression analysis indicated that patients with a temporal functional deficit zone, as identified by neuropsychological testing, had a 55.34% lower risk of an unfavorable outcome (adjusted HR: 0.4466, 95% CI: 0.236-0.854) compared to those with non-conclusive or extratemporal deficits. Concordance between video-electroencephalogram and brain magnetic resonance imaging findings in patients with right-sided lesions was also a protective factor (adjusted HR: 0.1868, 95% CI: 0.06-0.578). Discontinuation of anti-seizure treatment significantly increased the risk of an unfavorable outcome (adjusted HR: 6.718, 95% CI: 3.309-13.64).

Conclusion: Temporal lobe epilepsy surgery can achieve long-term seizure control in a significant proportion of patients. Neuropsychological assessment and concordance between MRI and video-EEG are essential presurgical factors for favorable outcomes. Additionally, patients should continue with antiepileptic treatment post-surgery to prevent seizure recurrence.

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来源期刊

Neurochirurgie 医学-临床神经学

CiteScore

2.70

自引率

6.20%

发文量

100

审稿时长

29 days

期刊介绍： Neurochirurgie publishes articles on treatment, teaching and research, neurosurgery training and the professional aspects of our discipline, and also the history and progress of neurosurgery. It focuses on pathologies of the head, spine and central and peripheral nervous systems and their vascularization. All aspects of the specialty are dealt with: trauma, tumor, degenerative disease, infection, vascular pathology, and radiosurgery, and pediatrics. Transversal studies are also welcome: neuroanatomy, neurophysiology, neurology, neuropediatrics, psychiatry, neuropsychology, physical medicine and neurologic rehabilitation, neuro-anesthesia, neurologic intensive care, neuroradiology, functional exploration, neuropathology, neuro-ophthalmology, otoneurology, maxillofacial surgery, neuro-endocrinology and spine surgery. Technical and methodological aspects are also taken onboard: diagnostic and therapeutic techniques, methods for assessing results, epidemiology, surgical, interventional and radiological techniques, simulations and pathophysiological hypotheses, and educational tools. The editorial board may refuse submissions that fail to meet the journal''s aims and scope; such studies will not be peer-reviewed, and the editor in chief will promptly inform the corresponding author, so as not to delay submission to a more suitable journal. With a view to attracting an international audience of both readers and writers, Neurochirurgie especially welcomes articles in English, and gives priority to original studies. Other kinds of article - reviews, case reports, technical notes and meta-analyses - are equally published. Every year, a special edition is dedicated to the topic selected by the French Society of Neurosurgery for its annual report.