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Preoperative prediction of temporal lobe epilepsy surgery outcome
- Source :
- Epilepsy Research. 127:331-338
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Purpose There is controversy about relative contributions of ictal scalp video EEG recording (vEEG), routine scalp outpatient interictal EEG (rEEG), intracranial EEG (iEEG) and MRI for predicting seizure-free outcomes after temporal lobectomy. We reviewed NIH experience to determine contributions at specific time points as well as long-term predictive value of standard pre-surgical investigations. Methods Raw data was obtained via retrospective chart review of 151 patients. After exclusions, 118 remained (median 5 years follow-up). MRI-proven mesial temporal sclerosis (MTSr) was considered a separate category for analysis. Logistic regression estimated odds ratios at 6-months, 1-year, and 2 years; proportional hazard models estimated long-term comparisons. Subset analysis of the proportional hazard model was performed including only patients with commonly encountered situations in each of the modalities, to maximize statistical inference. Results Any MRI finding, MRI proven MTS, rEEG, vEEG and iEEG did not predict two-year seizure-free outcome. MTSr was predictive at six months (OR=2.894, p=0. 0466), as were MRI and MTSr at one year (OR=10.4231, p=0. 0144 and OR=3.576, p=0. 0091). Correcting for rEEG and MRI, vEEG failed to predict outcome at 6 months, 1year and 2 years. Proportional hazard analysis including all available follow-up failed to achieve significance for any modality. In the subset analysis of 83 patients with commonly encountered results, vEEG modestly predicted long-term seizure-free outcomes with a proportional hazard ratio of 1.936 (p=0.0304). Conclusions In this study, presurgical tools did not provide unambiguous long-term outcome predictions. Multicenter prospective studies are needed to determine optimal presurgical epilepsy evaluation.
- Subjects :
- Adult
Male
Subset Analysis
medicine.medical_specialty
Time Factors
Kaplan-Meier Estimate
Electroencephalography
Article
03 medical and health sciences
0302 clinical medicine
Seizures
medicine
Humans
Epilepsy surgery
Ictal
030212 general & internal medicine
Prospective cohort study
Proportional Hazards Models
Retrospective Studies
Sclerosis
medicine.diagnostic_test
Proportional hazards model
Hazard ratio
Odds ratio
Anterior Temporal Lobectomy
Prognosis
Magnetic Resonance Imaging
Surgery
Logistic Models
Treatment Outcome
Epilepsy, Temporal Lobe
Neurology
Preoperative Period
Female
Neurology (clinical)
Radiology
Psychology
030217 neurology & neurosurgery
Follow-Up Studies
Subjects
Details
- ISSN :
- 09201211
- Volume :
- 127
- Database :
- OpenAIRE
- Journal :
- Epilepsy Research
- Accession number :
- edsair.doi.dedup.....04bbc2bae22da66afa09ed6954836ace