Prognosis after temporal lobe epilepsy surgery: The value of combining predictors
Version of Record online: 28 JUN 2008
© 2008 International League Against Epilepsy
Volume 49, Issue 8, pages 1317–1323, August 2008
How to Cite
Uijl, S. G., Leijten, F. S.S., Arends, J. B.A.M., Parra, J., Van Huffelen, A. C. and Moons, K. G.M. (2008), Prognosis after temporal lobe epilepsy surgery: The value of combining predictors. Epilepsia, 49: 1317–1323. doi: 10.1111/j.1528-1167.2008.01695.x
- Issue online: 28 JUL 2008
- Version of Record online: 28 JUN 2008
- Accepted April 29, 2008; Online Early publication June 13, 2008.
- Temporal lobe epilepsy;
- Surgical treatment;
Purpose: Although several independent predictors of seizure freedom after temporal lobe epilepsy surgery have been identified, their combined predictive value is largely unknown. Using a large database of operated patients, we assessed the combined predictive value of previously reported predictors included in a single multivariable model.
Methods: The database comprised a cohort of 484 patientswho underwent temporal lobe surgery for drug-resistant epilepsy. Good outcome was defined as Engel class 1, one year after surgery. Previously reported independent predictors were tested in this cohort. To be included in our final prediction model, predictors had to show a multivariable p-value of <0.20.
Results: The final multivariable model included predictors obtained from the patient's history (absence of tonic–clonic seizures, absence of status epilepticus), magnetic resonance imaging [MRI; ipsilateral mesial temporal sclerosis (MTS), space occupying lesion], video electroencephalography (EEG; absence of ictal dystonic posturing, concordance between MRI and ictal EEG), and fluorodeoxyglucose positron emission tomography (FDG-PET; unilateral temporal abnormalities), that were related to seizure freedom in our data. The model showed an expected receiver-operating characteristic curve (ROC) area of 0.63 [95% confidence interval (CI) 0.57–0.68] for new patient populations. Intracranial monitoring and surgery-related parameters (including histology) were not important predictors of seizure freedom. Among patients with a high probability of seizure freedom, 85% were seizure-free one year after surgery; however, among patients with a high risk of not becoming seizure-free, still 40% were seizure-free one year after surgery.
Conclusion: We could only moderately predict seizure freedom after temporal lobe epilepsy surgery. It is particularly difficult to predict who will not become seizure-free after surgery.