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“Time is Brain”—How early should surgery be done in drug‐resistant TLE ?
Author(s) -
Radhakrishnan Ashalatha,
Me Ramshekhar,
Thomas Sanjeev V.,
Abraham Mathew,
Vilanilam George,
Kesavadas Chandrashekharan,
Thomas Bejoy,
Cherian Ajith,
Varma Ravi Prasad
Publication year - 2018
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.13008
Subject(s) - epilepsy , proportional hazards model , temporal lobe , anterior temporal lobectomy , epilepsy surgery , medicine , surgery , hazard ratio , anesthesia , psychiatry , confidence interval
Objectives To explore the effect of duration of epilepsy and delay in surgery on seizure outcome in patients operated for drug‐resistant temporal lobe epilepsy ( TLE ). Materials & methods A total of 664 consecutive patients who underwent anterior temporal lobectomy ( ATL ) for TLE from 1995 to 2008 formed the study cohort. We divided them into two, one as seizure‐free with or without antiepileptic drugs after ATL as “good outcome” (Engel class I a) and seizures of any type, any time after surgery as “poor outcome.” The probability of seizure freedom/seizure recurrence based on the duration of epilepsy was compared using Kaplan‐Meier curves, univariate Cox regression survival analysis, and multivariate Cox proportional hazards regression model. Results A total of 136 children and 528 adults underwent ATL during this period. Mean duration of epilepsy pre‐ ATL was 17.1 + 9.4 years. At mean follow‐up of 8.5 years, 331 patients (49.8%) had good outcome and 333 (50.2%) had poor outcome. The hazard of seizure recurrence linearly increased with duration of epilepsy pre‐ ATL , from 1.5 (duration of epilepsy, 5‐10 years) to 1.9 (duration of epilepsy, 10‐15 years) to 2 (duration of epilepsy over 15 years). In addition, encephalitis as antecedent, bilateral mesial temporal sclerosis in MRI , normal histopathology, and spikes in postoperative EEG at 3 months and 1 year predicted poor seizure outcome. Conclusions “Epilepsy duration” independently predicted both short‐ and long‐term seizure outcome after surgery in TLE . “Lost years” translate into poor seizure outcome after ATL . Therefore, all cases of drug‐resistant TLE should be referred to a surgical center at the earliest.