Improvement and Deterioration of Seizure Control During the Postsurgical Course of Epilepsy Surgery Patients

Authors

  • D. M. Ficker,

    1. Division of Epilepsy and Section of Electroencephalography, Mayo Clinic and Mayo Medical School, Rochester, Minnesota, U.S.A.
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  • E. L. So,

    Corresponding author
    1. Division of Epilepsy and Section of Electroencephalography, Mayo Clinic and Mayo Medical School, Rochester, Minnesota, U.S.A.
      Address correspondence and reprint requests to Dr. E. L. So at Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, U.S.A.
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  • R. K. Mosewich,

    1. Division of Epilepsy and Section of Electroencephalography, Mayo Clinic and Mayo Medical School, Rochester, Minnesota, U.S.A.
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  • K. Radhakrishnan,

    1. Division of Epilepsy and Section of Electroencephalography, Mayo Clinic and Mayo Medical School, Rochester, Minnesota, U.S.A.
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  • G. D. Cascino,

    1. Division of Epilepsy and Section of Electroencephalography, Mayo Clinic and Mayo Medical School, Rochester, Minnesota, U.S.A.
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  • F. W. Sharbrough

    1. Division of Epilepsy and Section of Electroencephalography, Mayo Clinic and Mayo Medical School, Rochester, Minnesota, U.S.A.
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  • Current address of Dr. So: Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH.

  • Presented in part at the 49th Annual Scientific Meeting of the American Academy of Neurology, April 1997, Boston, Massachusetts.

Address correspondence and reprint requests to Dr. E. L. So at Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, U.S.A.

Abstract

Summary: Purpose: To determine the factors associated with changes in seizure control during the postsurgical course of epilepsy surgery patients.

Methods: Evaluation of patients after consecutive temporal and frontal resection whose seizure frequency was scored for each year of postsurgical follow-up. In each cohort, patients with a change in their seizure control after the first postsurgical year were compared with control subjects to determine factors that may be responsible for the change.

Results: Thirty-three (15%) of 214 temporal lobectomy versus 12 (20%) of 59 frontal resection patients experienced a change in seizure control (p < 0.05). Ten (5%) of 214 temporal lobectomy versus nine (15%) of 59 frontal resection patients experienced an improvement in seizure control (p = 0.009), but 23 (11%) of 214 temporal lobectomy versus three (5%) of 59 frontal resection patients had a worsening in seizure control (p < 0.05). In temporal lobectomy patients, preoperative unilateral temporal epileptiform discharges were associated with improvement (p = 0.03), whereas older age at surgery was associated with worsening of seizure control (p = 0.007). In frontal resection patients, presence of a congenital central nervous system (CNS) anomaly was associated with late improvement in seizure control (p = 0.006).

Conclusion: During the postsurgical course, an improvement in seizure control is more common after frontal resection than after temporal lobectomy. Factors associated with improvement are the presence of a congenital CNS abnormality in frontal resection patients, and the occurrence of preoperative unilateral epileptiform discharges in temporal lobectomy patients. Older age at temporal lobectomy may be associated with greater risk of worsening seizure control.

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