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 : 2025-01-01 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.

查看原文本刊更多论文

成人单侧内侧颞叶癫痫手术的发作结局及相关因素。

目的：分析接受颞叶切除术的成人耐药单侧内侧颞叶癫痫患者的术后癫痫发作结局及不良癫痫控制（Engel III-IV）相关因素。方法：这是一项观察性、纵向和回顾性研究。对社会人口学、临床和临床特征进行描述性分析。计算癫痫发作控制不充分的发生率，并绘制Kaplan-Meier曲线。进行Cox回归分析以确定与不良结果相关的因素。结果：共纳入285例患者，其中56.4%为女性，49.12%行标准颞叶切除术。70.87%的患者达到Engel I， 6.31%的患者出现术后并发症。不良结局的估计发生率为3.87例/ 100人年（95% CI: 3.51-4.27）。Cox回归分析显示，与非结论性或颞外功能缺损患者相比，经神经心理测试确定的颞功能缺损区患者出现不良结局的风险降低55.34%（调整后HR: 0.4466, 95% CI: 0.236-0.854）。右侧病变患者的视频脑电图和脑磁共振成像结果的一致性也是一个保护因素（调整后HR: 0.1868, 95% CI: 0.06-0.578）。停止抗癫痫治疗显著增加了不良结局的风险（调整后HR: 6.718, 95% CI: 3.309-13.64）。结论：颞叶癫痫手术可使相当比例的患者实现长期癫痫控制。神经心理学评估和MRI与视频脑电图的一致性是手术前良好预后的重要因素。此外，术后患者应继续抗癫痫治疗，防止癫痫复发。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.