Long-term outcome of lesional posterior cortical epilepsy surgery in adults

J Neurol Neurosurg Psychiatry. 2009 Jul;80(7):773-80. doi: 10.1136/jnnp.2008.164145. Epub 2009 Mar 25.

Abstract

Objective: The aim of this study was to evaluate the short- and long-term seizure outcome and to find predictors of outcome after epilepsy surgery in lesional posterior cortical epilepsies (PCEs).

Methods: The operative outcome in 80 consecutive adult patients with lesional PCEs who underwent resective surgery for intractable partial epilepsy between 1991 and 2006 was retrospectively studied.

Results: The probability of remaining in Engel Class I was 66.3% (95% CI 60 to 72) at 6 months, 52.5% (95% CI 47 to 57) at 2 years, 52.9% (CI 45 to 59) at 5 years and 47.1% (CI 42 to 52) at 10 years. Factors predicting poor outcome were the presence of a somatosensory aura, extraregional spikes, incomplete resection, interictal epileptiform discharge (IED) in EEG 6 months and 2 years postsurgery, history of generalised tonic-clonic seizure (GT-CS) and the presence of focal cortical dysplasia in the resected specimen. Factors predicting good outcome were childhood onset of epilepsy, short epilepsy duration, ipsilateral spikes, visual aura, presence of well-circumscribed lesion in preoperative MRI and a pathologically defined tumour. In the multivariate analysis, predictors were different in the long and short term as follows: incomplete resection as proven by postoperative MRI (hazard ratio (HR) 2.059 (CI 1.19 to 3.67)) predicts seizure relapse in short-term follow-up. The presence of IED in the EEG performed 6 months after surgery (HR 2.3 (CI 1.128 to 4.734)) predicts seizure relapse in the long-term fellow-up. However, the absence of a history of GT-CS independently predicts seizure remission in short- and long-term follow-up.

Conclusions: Surgery in PCEs proved to be effective in short- and long-term follow-up. Lesional posterior cortical epilepsy may be a progressive process in a substantial number of cases.

MeSH terms

  • Adult
  • Age of Onset
  • Cerebral Cortex / pathology
  • Cerebral Cortex / physiopathology*
  • Cerebral Cortex / surgery*
  • Electroencephalography
  • Epilepsies, Partial / pathology
  • Epilepsies, Partial / physiopathology*
  • Epilepsies, Partial / surgery*
  • Epilepsy, Partial, Sensory / physiopathology
  • Epilepsy, Partial, Sensory / surgery
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Multivariate Analysis
  • Neurosurgery / methods*
  • Outcome Assessment, Health Care
  • Postoperative Period
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Seizures / physiopathology
  • Seizures / surgery
  • Time Factors
  • Treatment Outcome
  • Young Adult