Abstract Details

Title Predictors of Seizure Recurrence and Longitudinal Outcome after Epilepsy Surgery

Topic Epilepsy

Presentation(s) P04 - (-)

Poster/Presentation
Number 198

Objective

Background BACKGROUND: Although studies have shown favorable results at fixed intervals after epilepsy surgery, the longitudinal outcome remains poorly understood.

Design/Methods DESIGN/METHODS: We retrospectively identified consecutive patients who underwent epilepsy surgery between January 2009 and August 2012, and extracted relevant characteristics. We defined outcome as favorable (Engel I/II) or unfavorable (III/IV) at 6-month, 1-year and 2-year follow-ups. We evaluated outcome using univariate and survival analyses.

Results RESULTS: Among 48 operated patients (21-68 years, 25 male), there were 37 (77%) temporal and 11 (23%) extratemporal resections. Intracranial monitoring and intraoperative electrocorticography were done in 7 and 23 patients respectively. Mean epilepsy duration was 15 years. MRI was normal in 10 (21%), abnormal in 38 (79%); abnormalities included MTS (n=22), tumor (n=5), other (n=11). In 4, abnormalities extended beyond the intended resection. In 44 patients with a 6-month minimum follow-up, outcome at last follow-up (mean 17 months) was favorable in 82% (n=36, temporal 30, extratemporal 6) and unfavorable in 18% (n=8, temporal 3, extratemporal 5). Extratemporal seizure onset predicted unfavorable outcome at 1 and 2 years (p=0.035, 0.037). Discordance between EEG onset and resection (p=0.108), and presence of widespread MRI lesions (p=0.065) tended to predict unfavorable outcome only at 2 years. Outcome was not associated with age, gender, history of generalized seizures, epilepsy duration, preoperative seizure frequency, Wada memory impairment, interictal EEG, lesional status or pathology. Presumed reasons for unfavorable outcome were inadequate seizure focus localization and incomplete resection. Survival analysis showed that the chance of recurrence was lower for temporal than extratemporal resections (p=0.001, logrank test). At 1 year, recurrence risk leveled off for temporal resections but not for extratemporal resections.

Conclusions CONCLUSIONS: Extratemporal epilepsy, discordant EEG and widespread MRI abnormalities can be associated with unfavorable outcome. One year seizure freedom supports future seizure freedom after temporal resections.

Authors/Disclosures
Hai Chen, MD, PhD PRESENTER	Dr. Chen has nothing to disclose.
Mark Agostini, MD (U.T. Southwestern Medical Center)	Dr. Agostini has nothing to disclose.
Kan Ding, MD (UT Southwestern Medical Center)	The institution of Dr. Ding has received research support from National Institute of Aging. The institution of Dr. Ding has received research support from NINDS.
Puneet K. Gupta, MD (Neurology Consultants of Dallas, PA)	No disclosure on file
	No disclosure on file
	No disclosure on file
Paul C. Van Ness, MD, FAAN	No disclosure on file
Pradeep N. Modur, MD (Seton Brain & Spine Institute, University of Texas)	No disclosure on file
Francesco Patti, MD	Dr. Patti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. The institution of Dr. Patti has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Almirall. Dr. Patti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Meyers. Dr. Patti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Johnson and Johnson. The institution of Dr. Patti has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck. The institution of Dr. Patti has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. The institution of Dr. Patti has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. The institution of Dr. Patti has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Patti has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Almirall, Bayer, Biogen, Bristol Meyers and Squibb Merck, Roche, Sanofi, TEVA. Dr. Patti has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for University of Catania and AISM/FISM, Fondazione Italiana Sclerosi Multipla. Dr. Patti has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers in Neurology.

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