Long-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients

J Neurosurg. 2009 Jun;110(6):1135-46. doi: 10.3171/2008.6.JNS17613.


Object: The aim of this study was to evaluate the long-term efficacy of temporal lobe epilepsy (TLE) surgery and potential risk factors for seizure recurrence after surgery.

Methods: This retrospective study included 434 consecutive adult patients who underwent TLE surgery at Bethel Epilepsy Centre between 1991 and 2002.

Results: Hippocampal sclerosis was found in 62% of patients, gliosis in 17.3%, tumors in 20%, and focal cortical dysplasia (FCD) in 6.9%. Based on a Kaplan-Meier analysis, the probability of Engel Class I outcome for the patients overall was 76.2% (95% CI 71-81%) at 6 months, 72.3% (95% CI 68-76%) at 2 years, 71.1% (95% CI 67-75%) at 5 years, 70.8% (95% CI 65-75%) at 10 years, and 69.4% (95% CI 64-74%) at 16 years postoperatively. The likelihood of remaining seizure free after 2 years of freedom from seizures was 90% (95% CI 82-98%) for 16 years. Seizure relapse occurred in all subgroups. Patients with FCD had the highest risk of recurrence (hazard ratio 2.15, 95% CI 0.849-5.545). Predictors of remission were the presence of hippocampal atrophy on preoperative MR imaging and a family history of epilepsy. Predictors of relapse were the presence of bilateral interictal sharp waves and versive seizures. Six-month follow-up electroencephalography predicted relapse in patients with FCD. Short epilepsy duration was predictive of seizure remission in patients with tumors and gliosis; 28.1% of patients were able to discontinue antiepileptic medications without an increased risk of seizure recurrence (hazard ratio 1.05, 95% CI 0.933-1.20).

Conclusions: These findings highlight the role of etiology in prediction of long-term outcome after TLE surgery.

MeSH terms

  • Adolescent
  • Adult
  • Anterior Temporal Lobectomy*
  • Disease-Free Survival
  • Epilepsy, Temporal Lobe / etiology
  • Epilepsy, Temporal Lobe / pathology
  • Epilepsy, Temporal Lobe / surgery*
  • Female
  • Follow-Up Studies
  • Hippocampus / pathology
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Sclerosis
  • Treatment Outcome
  • Young Adult