Epilepsy surgery for pathologically proven hippocampal sclerosis provides long-term seizure control and improved quality of life

Epilepsia. 2004 Mar;45(3):237-42. doi: 10.1111/j.0013-9580.2004.35903.x.


Purpose: To examine long-term seizure and quality-of-life outcome in a homogeneous group of patients after temporal lobectomy with pathologically proven hippocampal sclerosis (HS). Previous research has had limited follow-up (generally <2 years) and has grouped patients across multiple pathologies.

Methods: Fifty consecutive patients were identified as having had a temporal lobectomy for the treatment of temporal lobe epilepsy at Royal Melbourne Hospital with pathologically proven HS and >or=2 years' follow-up. All patients were sent a postal survey concerning seizure activity, quality of life (QOLIE-89), and antiepileptic drug (AED) use. The mean follow-up was 5.8 years (range, 2-9.2).

Results: The rate of complete postoperative seizure freedom was 82% at 12 months, 76% at 24 months, and 64% at 63 months (no further seizure recurrences observed after this time). A class I seizure outcome was achieved by 83.3% of patients. Patients with better seizure outcome had significantly better quality of life (Kendall's tau =-234, p < 0.01). Seizure recurrence was associated with a reduction in AED intake or absorption in five (29%) of 17 cases, including three of the five patients with a first seizure recurrence after 24 months after surgery.

Conclusions: Temporal lobectomy provides continued long-term seizure control in the majority of patients with HS. However, patients remain at risk of seizure recurrence >or=2 years after surgery. Long-term quality of life is dependent on seizure outcome.

MeSH terms

  • Adolescent
  • Adult
  • Epilepsy, Temporal Lobe / etiology
  • Epilepsy, Temporal Lobe / surgery*
  • Female
  • Follow-Up Studies
  • Hippocampus / pathology*
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods*
  • Preoperative Care
  • Quality of Life
  • Sclerosis / complications
  • Sclerosis / pathology
  • Treatment Outcome