Latency to first seizure after temporal lobectomy predicts long-term outcome

Authors

  • Sarah E. Buckingham,

    1. Jefferson Medical College, Philadelphia, Pennsylvania, U.S.A.
    Search for more papers by this author
  • Inna Chervoneva,

    1. Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    Search for more papers by this author
  • Ashwini Sharan,

    1. Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    2. Department of Neurosurgery, Jefferson Medical College, Philadelphia, Pennsylvania, U.S.A.
    Search for more papers by this author
  • Andro Zangaladze,

    1. Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    2. Department of Neurology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    Search for more papers by this author
  • Scott Mintzer,

    1. Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    2. Department of Neurology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    Search for more papers by this author
  • Christopher Skidmore,

    1. Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    2. Department of Neurology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    Search for more papers by this author
  • Maromi Nei,

    1. Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    2. Department of Neurology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    Search for more papers by this author
  • James Evans,

    1. Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    2. Department of Neurosurgery, Jefferson Medical College, Philadelphia, Pennsylvania, U.S.A.
    Search for more papers by this author
  • Edward Pequignot,

    1. Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    Search for more papers by this author
  • Michael R. Sperling

    1. Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    2. Department of Neurology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
    Search for more papers by this author

  • Statistical analyses were completed by I. Chervoneva, E. Pequignot.

Address correspondence to Michael R. Sperling, Jefferson Comprehensive Epilepsy Center, 900 Walnut Street, Philadelphia, PA 19107, U.S.A. E-mail: michael.sperling@jefferson.edu

Summary

Purpose: Temporal lobectomy is a well-established treatment for refractory temporal lobe epilepsy, yet many patients experience at least one seizure postoperatively. Little is known about the prognostic significance of the time from surgery to first seizure relapse in predicting long-term outcome.

Methods: In a retrospective analysis of patients who reported at least one complex partial seizure (CPS) or generalized tonic–clonic seizure (GTCS) after anterior temporal lobectomy (n = 268), we used a nominal response logistic model to predict the odds ratio (OR) of a seizure outcome based on length of the latency period from surgery to first postoperative seizure. A modified Engel outcome class scheme was used. We controlled for factors known to influence postoperative outcome, including history of tonic–clonic seizures, intelligence quotient (IQ), preoperative seizure frequency, magnetic resonance imaging (MRI) findings, and history of febrile convulsions.

Results: In the univariate analysis, the latency from surgery to the first postoperative disabling seizure was significantly associated with long-term outcome. Longer latency was associated with higher odds of being seizure-free or improved (modified Engel’s classes 1, 2, and 3) relative to the unimproved state (class 4) (p < 0.001, 0.001 and 0.004, respectively). Conversely, a shorter latency increased the likelihood of achieving the worst prognosis (class 4) relative to class 1 (p < 0.001). Multivariate analysis yielded similar results.

Discussion: Latency to the first postoperative seizure predicts long-term outcome, with short latencies portending poor prognosis and long latencies portending a good prognosis. This information can be used for patient counseling and may influence decisions regarding reoperation.

Ancillary