Postsurgical seizure outcome in temporal lobe epilepsy patients with normal or subtle, nonspecific MRI findings

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  • 1 Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada;
  • | 2 Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California;
  • | 3 Department of Neurology, National Neuroscience Institute, Singapore;
  • | 4 Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada;
  • | 5 Department of Pathology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; and
  • | 6 PET Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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OBJECTIVE

The authors’ objective was to report postsurgical seizure outcome of temporal lobe epilepsy (TLE) patients with normal or subtle, nonspecific MRI findings and to identify prognostic factors related to seizure control after surgery.

METHODS

This was a retrospective study of patients who underwent surgery from 1999 to 2014 at two comprehensive epilepsy centers. Patients with a clear MRI lesion according to team discussion and consensus were excluded. Presurgical information, surgery details, pathological data, and postsurgical outcomes were retrospectively collected from medical charts. Multiple logistic regression analysis was used to assess the effect of clinical, surgical, and neuroimaging factors on the probability of Engel class I (favorable) versus class II–IV (unfavorable) outcome at last follow-up.

RESULTS

The authors included 73 patients (59% were female; median age at surgery 35.9 years) who underwent operations after a median duration of epilepsy of 13 years. The median follow-up after surgery was 30.6 months. At latest follow-up, 44% of patients had Engel class I outcome. Favorable prognostic factors were focal nonmotor aware seizures and unilateral or no spikes on interictal scalp EEG.

CONCLUSIONS

Favorable outcome can be achieved in a good proportion of TLE patients with normal or subtle, nonspecific MRI findings, particularly when presurgical investigation suggests a rather circumscribed generator. Presurgical factors such as the presence of focal nonmotor aware seizures and unilateral or no spikes on interictal EEG may indicate a higher probability of seizure freedom.

ABBREVIATIONS

ATL = anterior temporal lobe; FBTC = focal to bilateral tonic-clonic; FCD = focal cortical dysplasia; HS = hippocampal sclerosis; iEEG = intracranial electroencephalography; IQR = interquartile range; MNI = Montreal Neurological Institute and Hospital; SAH = selective amygdalohippocampectomy; TLE = temporal lobe epilepsy; UCSF = University of California, San Francisco.

Supplementary Materials

    • Supplemental Material (PDF 443 KB)

Images from Minchev et al. (pp 479–488).

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