Prognostic factors and outcome after different types of resection for temporal lobe epilepsy

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Object. It is unknown whether different resection strategies for temporal lobe epilepsy (TLE) produce alterations in seizure control or neuropsychological performance.

Methods. A series of 321 patients who underwent surgery for TLE between 1989 and 1997 was submitted to a uniand multifactorial analysis of clinical, electrophysiological, neuroimaging, neuropsychological, and surgical factors to determine independent predictors of outcome. Until 1993, most patients with TLE underwent standard anterior temporal lobectomy (ATL); beginning in 1993, surgical procedures were increasingly restricted to lesions detected on magnetic resonance (MR) imaging and the presumed epileptogenic foci: for example, amygdalohippocampectomy (AH) or lesionectomy/corticectomy began to be used more often.

The mean follow-up duration in this study was 38 months. Two hundred twenty-seven patients were classified as seizure free (70.7%), and 36 patients had rare and nondisabling seizures (11.2%); these groups were summarized as having good seizure control (81.9%). Twenty-four patients attained more than 75% improvement (7.5%), and no worthwhile improvement was seen in 34 cases (10.6%); these groups were summarized as having unsatisfactory seizure control (18.1%).

On unifactorial analysis the following preoperative factors were associated with good seizure control (p < 0.05): single and concordant lateralizing focus on electroencephalography studies, low seizure frequency, absence of status epilepticus, concordant lateralizing memory deficit, clear abnormality on MR images, suspected ganglioglioma or dysembryoplastic neuroepithelial tumor (DNT), and absence of dysplasia on MR images. Stepwise logistic regression revealed a model containing five factors that were predictive for good seizure control (p < 0.1): 1) clear abnormality on MR images; 2) absence of status epilepticus; 3) MR imaging—confirmed ganglioglioma or DNT; 4) concordant lateralizing memory deficit; and 5) absence of dysplasia on MR images. Seizure outcome was mainly correlated with diagnosis and clinical factors. No significant differences were found regarding different resection types performed for comparable tumors. Neuropsychological testing revealed better postoperative results after limited resections compared with standard ATL, especially with regard to attention level, verbal memory, and calculated total neuropsychological performance.

Conclusions. Different strategies for surgical approaches in TLE result in equally good outcomes. Seizure outcome is mainly dependent on the diagnosis and clinical factors, whereas the neuropsychological results are more beneficial after resections limited to an epileptogenic lesion and focus.

Article Information

Address reprint requests to: Hans Clusmann, M.D., Neurochirurgische Universitätsklinik, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. email: hans.clusmann@ukb.uni-bonn.de.

© AANS, except where prohibited by US copyright law.

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    Bar graph showing seizure outcome in 321 patients in relation to preoperative seizure frequency per month. Seizure outcomes were summarized as good seizure control (Classes I and II) and unsatisfactory seizure control (Classes III and IV). The trend of continuously decreasing surgical success rates with greater preoperative seizure frequency is statistically significant (p = 0.031, Cochran—Armitage trend test). N = number of patients.

References

1.

Amthauer R: I-S-T 70 Intelligenz-Struktur-Test. Göttingen: Hogrefe1973Amthauer R: I-S-T 70 Intelligenz-Struktur-Test. Göttingen: Hogrefe 1973

2.

Armon CRadtke RAFriedman AHet al: Predictors of outcome of epilepsy surgery: multivariate analysis with validation. Epilepsia 37:8148211996Armon C Radtke RA Friedman AH et al: Predictors of outcome of epilepsy surgery: multivariate analysis with validation. Epilepsia 37:814–821 1996

3.

Arruda FCendes FAndermann Fet al: Mesial atrophy and outcome after amygdalohippocampectomy or temporal lobe removal. Ann Neurol 40:4464501996Arruda F Cendes F Andermann F et al: Mesial atrophy and outcome after amygdalohippocampectomy or temporal lobe removal. Ann Neurol 40:446–450 1996

4.

Behrens ESchramm JZentner Jet al: Surgical and neurological complications in a series of 708 epilepsy surgery procedures. Neurosurgery 41:1101997Behrens E Schramm J Zentner J et al: Surgical and neurological complications in a series of 708 epilepsy surgery procedures. Neurosurgery 41:1–10 1997

5.

Behrens EZentner Jvan Roost Det al: Subdural and depth electrodes in the presurgical evaluation of epilepsy. Acta Neurochir 128:84871994Behrens E Zentner J van Roost D et al: Subdural and depth electrodes in the presurgical evaluation of epilepsy. Acta Neurochir 128:84–87 1994

6.

Bengzon ARRasmussen TGloor Pet al: Prognostic factors in the surgical treatment of temporal lobe epileptics. Neurology 18:7177311968Bengzon AR Rasmussen T Gloor P et al: Prognostic factors in the surgical treatment of temporal lobe epileptics. Neurology 18:717–731 1968

7.

Berkovic SFMcIntosh AMKalnins RMet al: Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis. Neurology 45:135813631995Berkovic SF McIntosh AM Kalnins RM et al: Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis. Neurology 45:1358–1363 1995

8.

Brickenkamp R: Test d 2 Aufmerksamkeits-Belastungs-Test. Göttingen: Hogrefe1978Brickenkamp R: Test d 2 Aufmerksamkeits-Belastungs-Test. Göttingen: Hogrefe 1978

9.

Bronen RAFulbright RKKing Det al: Qualitative MR imaging of refractory temporal lobe epilepsy requiring surgery: correlation with pathology and seizure outcome after surgery. AJR 169:8758821997Bronen RA Fulbright RK King D et al: Qualitative MR imaging of refractory temporal lobe epilepsy requiring surgery: correlation with pathology and seizure outcome after surgery. AJR 169:875–882 1997

10.

Cendes FAndermann FDubeau Fet al: Early childhood prolonged febrile convulsions, atrophy and sclerosis of mesial structures, and temporal lobe epilepsy: an MRI volumetric study. Neurology 43:108310871993Cendes F Andermann F Dubeau F et al: Early childhood prolonged febrile convulsions atrophy and sclerosis of mesial structures and temporal lobe epilepsy: an MRI volumetric study. Neurology 43:1083–1087 1993

11.

Cendes FCook MJWatson Cet al: Frequency and characteristics of dual pathology in patients with lesional epilepsy. Neurology 45:205820641995Cendes F Cook MJ Watson C et al: Frequency and characteristics of dual pathology in patients with lesional epilepsy. Neurology 45:2058–2064 1995

12.

Daumas-Duport CScheithauer BWChodkiewicz JPet al: Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with intractable partial seizures. Report of thirty-nine cases. Neurosurgery 23:5455561988Daumas-Duport C Scheithauer BW Chodkiewicz JP et al: Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with intractable partial seizures. Report of thirty-nine cases. Neurosurgery 23:545–556 1988

13.

De Renzi EVignolo LA: The Token test: a sensitive test to detect receptive disturbances in aphasics. Brain 85:6656781962De Renzi E Vignolo LA: The Token test: a sensitive test to detect receptive disturbances in aphasics. Brain 85:665–678 1962

14.

Elger CEHufnagel ASchramm J: Epilepsy surgery protocol university hospital, Bonn, Germany in Lüders HO (ed): Epilepsy Surgery. New York: Raven Press1992 pp 783784Elger CE Hufnagel A Schramm J: Epilepsy surgery protocol university hospital Bonn Germany in Lüders HO (ed): Epilepsy Surgery. New York: Raven Press 1992 pp 783–784

15.

Engel J JrVan Ness PCRasmussen TBet al: Outcome with respect to epileptic seizures in Engel J Jr (ed): Surgical Treatment of the Epilepsiesed 2. New York: Raven Press1993 pp 609621Engel J Jr Van Ness PC Rasmussen TB et al: Outcome with respect to epileptic seizures in Engel J Jr (ed): Surgical Treatment of the Epilepsies ed 2. New York: Raven Press 1993 pp 609–621

16.

Foldvary NNashold BMascha Eet al: Seizure outcome after temporal lobectomy for temporal lobe epilepsy: a Kaplan-Meier survival analysis. Neurology 54:6306342000Foldvary N Nashold B Mascha E et al: Seizure outcome after temporal lobectomy for temporal lobe epilepsy: a Kaplan-Meier survival analysis. Neurology 54:630–634 2000

17.

Gilliam FBowling SBilir Eet al: Association of combined MRI, interictal EEG, and ictal EEG results with outcome and pathology after temporal lobectomy. Epilepsia 38:131513201997Gilliam F Bowling S Bilir E et al: Association of combined MRI interictal EEG and ictal EEG results with outcome and pathology after temporal lobectomy. Epilepsia 38:1315–1320 1997

18.

Goldstein LHPolkey CE: Short-term cognitive changes after uni-lateral temporal lobectomy or unilateral amygdalo-hippocampectomy for the relief of temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 56:1351401993Goldstein LH Polkey CE: Short-term cognitive changes after uni-lateral temporal lobectomy or unilateral amygdalo-hippocampectomy for the relief of temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 56:135–140 1993

19.

Grunwald TElger CELehnertz Ket al: Alterations of intrahippocampal cognitive potentials in temporal lobe epilepsy. Electroencephalogr Clin Neurophysiol 95:53621995Grunwald T Elger CE Lehnertz K et al: Alterations of intrahippocampal cognitive potentials in temporal lobe epilepsy. Electroencephalogr Clin Neurophysiol 95:53–62 1995

20.

Guldvog BLoyning YHauglie-Hanssen Eet al: Predictive factors for success in surgical treatment for partial epilepsy: a multivariate analysis. Epilepsia 35:5665781994Guldvog B Loyning Y Hauglie-Hanssen E et al: Predictive factors for success in surgical treatment for partial epilepsy: a multivariate analysis. Epilepsia 35:566–578 1994

21.

Helmstaedter CElger CEHufnagel Aet al: Different effects of left anterior temporal lobectomy, selective amygdalohippocampectomy, and temporal cortical lesionectomy on verbal learning, memory, and recognition. J Epilepsy 9:39451996Helmstaedter C Elger CE Hufnagel A et al: Different effects of left anterior temporal lobectomy selective amygdalohippocampectomy and temporal cortical lesionectomy on verbal learning memory and recognition. J Epilepsy 9:39–45 1996

22.

Helmstaedter CGrunwald TLehnertz Ket al: Differential involvement of left temporolateral and temporomesial structures in verbal declarative learning and memory: evidence from temporal lobe epilepsy. Brain Cogn 35:1101311997Helmstaedter C Grunwald T Lehnertz K et al: Differential involvement of left temporolateral and temporomesial structures in verbal declarative learning and memory: evidence from temporal lobe epilepsy. Brain Cogn 35:110–131 1997

23.

Helmstaedter CKurthen MLux Set al: Temporallappenepilepsie. Langsschnittliche Klinische, neuropsychologische und psychosoziale Entwicklung operativ und Konservativ behandelter Patienten. Nervenarzt 71:6296422000Helmstaedter C Kurthen M Lux S et al: Temporallappenepilepsie. Langsschnittliche Klinische neuropsychologische und psychosoziale Entwicklung operativ und Konservativ behandelter Patienten. Nervenarzt 71:629–642 2000

24.

Helmstaedter CLendt MLux S: VLMT Verbaler Lern- und Merkfähigkeitstest. Göttingen: Beltz Test GmbH2001Helmstaedter C Lendt M Lux S: VLMT Verbaler Lern- und Merkfähigkeitstest. Göttingen: Beltz Test GmbH 2001

25.

Helmstaedter CPohl CHufnagel Aet al: Visual learning deficits in nonresected patients with right temporal lobe epilepsy. Cortex 27:5475551991Helmstaedter C Pohl C Hufnagel A et al: Visual learning deficits in nonresected patients with right temporal lobe epilepsy. Cortex 27:547–555 1991

26.

Horn W: Leistungsprüfsystem L-P-S. Göttingen: Hogrefe1983Horn W: Leistungsprüfsystem L-P-S. Göttingen: Hogrefe 1983

27.

Hufnagel AElger CEPels Het al: Prognostic significance of ictal and interictal epileptiform activity in temporal lobe epilepsy. Epilepsia 35:114611531994Hufnagel A Elger CE Pels H et al: Prognostic significance of ictal and interictal epileptiform activity in temporal lobe epilepsy. Epilepsia 35:1146–1153 1994

28.

Ivnik RJSharbrough FWLaws ER Jr: Effects of anterior temporal lobectomy on cognitive function. J Clin Psychol 43:1281371987Ivnik RJ Sharbrough FW Laws ER Jr: Effects of anterior temporal lobectomy on cognitive function. J Clin Psychol 43:128–137 1987

29.

Jeong SWLee SKKim KKet al: Prognostic factors in anterior temporal lobe resections for mesial temporal lobe epilepsy: multivariate analysis. Epilepsia 40:173517391999Jeong SW Lee SK Kim KK et al: Prognostic factors in anterior temporal lobe resections for mesial temporal lobe epilepsy: multivariate analysis. Epilepsia 40:1735–1739 1999

30.

Katz AAwad IAKong AKet al: Extent of resection in temporal lobectomy for epilepsy. II. Memory changes and neurologic complications. Epilepsia 30:7637711989Katz A Awad IA Kong AK et al: Extent of resection in temporal lobectomy for epilepsy. II. Memory changes and neurologic complications. Epilepsia 30:763–771 1989

31.

Kleihues PBurger PCScheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3:2552681993Kleihues P Burger PC Scheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3:255–268 1993

32.

Kurthen MLukas MHufnagel Aet al: Correlations between verbal memory performance and electrocorticographically determined suppression of electrical brain activity in intracarotid amobarbital tests. Electroencephalogr Clin Neurophysiol 83:70761992Kurthen M Lukas M Hufnagel A et al: Correlations between verbal memory performance and electrocorticographically determined suppression of electrical brain activity in intracarotid amobarbital tests. Electroencephalogr Clin Neurophysiol 83:70–76 1992

33.

Lamberti GWeidlich S: DCS: A Visual Learning and Memory Test for Neuropsychological Assessment. Seattle: Hogrefe & Huber1999Lamberti G Weidlich S: DCS: A Visual Learning and Memory Test for Neuropsychological Assessment. Seattle: Hogrefe & Huber 1999

34.

McKhann GM IISchoenfeld-McNeill JBorn DEet al: Intraoperative hippocampal electrocorticography to predict the extent of hippocampal resection in temporal lobe epilepsy surgery. J Neurosurg 93:44522000McKhann GM II Schoenfeld-McNeill J Born DE et al: Intraoperative hippocampal electrocorticography to predict the extent of hippocampal resection in temporal lobe epilepsy surgery. J Neurosurg 93:44–52 2000

35.

Morris HHMatkovic ZEstes MLet al: Ganglioglioma and intractable epilepsy: clinical and neurophysiologic features and predictors of outcome after surgery. Epilepsia 39:3073131998Morris HH Matkovic Z Estes ML et al: Ganglioglioma and intractable epilepsy: clinical and neurophysiologic features and predictors of outcome after surgery. Epilepsia 39:307–313 1998

36.

Nayel MHAwad IALuders H: Extent of mesiobasal resection determines outcome after temporal lobectomy for intractable complex partial seizures. Neurosurgery 29:55611991Nayel MH Awad IA Luders H: Extent of mesiobasal resection determines outcome after temporal lobectomy for intractable complex partial seizures. Neurosurgery 29:55–61 1991

37.

Olivier A: Relevance of removal of limbic structures in surgery for temporal lobe epilepsy. Can J Neurol Sci 18:6286351991Olivier A: Relevance of removal of limbic structures in surgery for temporal lobe epilepsy. Can J Neurol Sci 18:628–635 1991

38.

Ozkara COzyurt EHanoglu Let al: Surgical outcome of epilepsy patients evaluated with a noninvasive protocol. Epilepsia 41 (Suppl 4):S41S442000Ozkara C Ozyurt E Hanoglu L et al: Surgical outcome of epilepsy patients evaluated with a noninvasive protocol. Epilepsia 41 (Suppl 4):S41–S44 2000

39.

Polkey CEBinnie CDJanota I: Acute hippocampal recording and pathology at temporal lobe resection and amygdalo-hippocampectomy for epilepsy. J Neurol Neurosurg Psychiatry 52:105010571989Polkey CE Binnie CD Janota I: Acute hippocampal recording and pathology at temporal lobe resection and amygdalo-hippocampectomy for epilepsy. J Neurol Neurosurg Psychiatry 52:1050–1057 1989

40.

Radhakrishnan KSo ELSilbert PLet al: Predictors of outcome of anterior temporal lobectomy for intractable epilepsy: a multivariate study. Neurology 51:4654711998Radhakrishnan K So EL Silbert PL et al: Predictors of outcome of anterior temporal lobectomy for intractable epilepsy: a multivariate study. Neurology 51:465–471 1998

41.

Raymond AAFish DRSisodiya SMet al: Abnormalities of gyration, heterotopias, tuberous sclerosis, focal cortical dysplasia, microdysgenesis, dysembryoplastic neuroepithelial tumor and dysgenesis of the archicortex in epilepsy. Clinical, EEG and neuroimaging features in 100 adult patients. Brain 118:6296601995Raymond AA Fish DR Sisodiya SM et al: Abnormalities of gyration heterotopias tuberous sclerosis focal cortical dysplasia microdysgenesis dysembryoplastic neuroepithelial tumor and dysgenesis of the archicortex in epilepsy. Clinical EEG and neuroimaging features in 100 adult patients. Brain 118:629–660 1995

42.

Raymond AAFish DRStevens JMet al: Association of hippocampal sclerosis with cortical dysgenesis in patients with epilepsy. Neurology 44:184118451994Raymond AA Fish DR Stevens JM et al: Association of hippocampal sclerosis with cortical dysgenesis in patients with epilepsy. Neurology 44:1841–1845 1994

43.

Raymond AAHalpin SFAlsanjari Net al: Dysembryoplastic neuroepithelial tumor. Features in 16 patients. Brain 117:4614751994Raymond AA Halpin SF Alsanjari N et al: Dysembryoplastic neuroepithelial tumor. Features in 16 patients. Brain 117:461–475 1994

44.

Roberts DW: Technical advances in the surgical treatment of epilepsy. Adv Neurol 84:6436492000Roberts DW: Technical advances in the surgical treatment of epilepsy. Adv Neurol 84:643–649 2000

45.

Schramm JKral TGrunwald Tet al: Surgical treatment for neocortical temporal lobe epilepsy: clinical and surgical aspects and seizure outcome. J Neurosurg 94:33422001Schramm J Kral T Grunwald T et al: Surgical treatment for neocortical temporal lobe epilepsy: clinical and surgical aspects and seizure outcome. J Neurosurg 94:33–42 2001

46.

Schulz RLuders HOHoppe Met al: Interictal EEG and ictal scalp EEG propagation are highly predictive of surgical outcome in mesial temporal lobe epilepsy. Epilepsia 41:5645702000Schulz R Luders HO Hoppe M et al: Interictal EEG and ictal scalp EEG propagation are highly predictive of surgical outcome in mesial temporal lobe epilepsy. Epilepsia 41:564–570 2000

47.

So ELRadhakrishnan KSilbert PLet al: Assessing changes over time in temporal lobectomy: outcome by scoring seizure frequency. Epilepsy Res 27:1191251997So EL Radhakrishnan K Silbert PL et al: Assessing changes over time in temporal lobectomy: outcome by scoring seizure frequency. Epilepsy Res 27:119–125 1997

48.

Spencer DDSpencer SS: Surgery for epilepsy. Neurol Clin 3:3133301985Spencer DD Spencer SS: Surgery for epilepsy. Neurol Clin 3:313–330 1985

49.

Spencer SS: The relative contributions of MRI, SPECT, and PET imaging in epilepsy. Epilepsia 35 (Suppl 6):S72S891994Spencer SS: The relative contributions of MRI SPECT and PET imaging in epilepsy. Epilepsia 35 (Suppl 6):S72–S89 1994

50.

Spencer SSSpencer DDWilliamson PDet al: Combined depth and subdural electrode investigation in uncontrolled epilepsy. Neurology 40:74791990Spencer SS Spencer DD Williamson PD et al: Combined depth and subdural electrode investigation in uncontrolled epilepsy. Neurology 40:74–79 1990

51.

Sperling MRSaykin AJGlosser Get al: Predictors of outcome after anterior temporal lobectomy: the intracarotid amobarbital test. Neurology 44:232523301994Sperling MR Saykin AJ Glosser G et al: Predictors of outcome after anterior temporal lobectomy: the intracarotid amobarbital test. Neurology 44:2325–2330 1994

52.

Wechsler D: Die Messung Der Intelligenz Erwachsener. Stuttgart: Huber1956Wechsler D: Die Messung Der Intelligenz Erwachsener. Stuttgart: Huber 1956

53.

Wieser HGYaşargil MG: Selective amygdalohippocampectomy as a surgical treatment of mesiobasal limbic epilepsy. Surg Neurol 17:4454571982Wieser HG Yaşargil MG: Selective amygdalohippocampectomy as a surgical treatment of mesiobasal limbic epilepsy. Surg Neurol 17:445–457 1982

54.

Wolf HKCampos MGZentner Jet al: Surgical pathology of temporal lobe epilepsy. Experience with 216 cases. J Neuropathol Exp Neurol 52:4995061993Wolf HK Campos MG Zentner J et al: Surgical pathology of temporal lobe epilepsy. Experience with 216 cases. J Neuropathol Exp Neurol 52:499–506 1993

55.

Wyler ARHermann BPRichey ET: Results of reoperation for failed epilepsy surgery. J Neurosurg 71:8158191989Wyler AR Hermann BP Richey ET: Results of reoperation for failed epilepsy surgery. J Neurosurg 71:815–819 1989

56.

Yaşargil MGTeddy PJRoth P: Selective amygdalo-hippocampectomy. Operative anatomy and surgical technique. Adv Tech Stand Neurosurg 12:931231985Yaşargil MG Teddy PJ Roth P: Selective amygdalo-hippocampectomy. Operative anatomy and surgical technique. Adv Tech Stand Neurosurg 12:93–123 1985

57.

Zentner JHufnagel AWolf HKet al: Surgical treatment of temporal lobe epilepsy: clinical, radiological, and histopathological findings in 178 patients. J Neurol Neurosurg Psychiatry 58:6666731995Zentner J Hufnagel A Wolf HK et al: Surgical treatment of temporal lobe epilepsy: clinical radiological and histopathological findings in 178 patients. J Neurol Neurosurg Psychiatry 58:666–673 1995

58.

Zentner JWolf HKOstertun Bet al: Gangliogliomas: clinical, radiological, and histopathological findings in 51 patients. J Neurol Neurosurg Psychiatry 57:149715021994Zentner J Wolf HK Ostertun B et al: Gangliogliomas: clinical radiological and histopathological findings in 51 patients. J Neurol Neurosurg Psychiatry 57:1497–1502 1994

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