'Time is Brain'-How early should surgery be done in drug-resistant TLE?

Autor:	Ramshekhar N. Menon, Mathew Abraham, Sanjeev V Thomas, Ajith Cherian, Chandrashekharan Kesavadas, George C Vilanilam, Ashalatha Radhakrishnan, Ravi Prasad Varma, Bejoy Thomas
Rok vydání:	2018
Předmět:	Adult Male Drug Resistant Epilepsy medicine.medical_specialty Time Factors Adolescent medicine.medical_treatment Electroencephalography Temporal lobe Young Adult 03 medical and health sciences Epilepsy 0302 clinical medicine medicine Humans Epilepsy surgery 030212 general & internal medicine Child Survival analysis Anterior temporal lobectomy Proportional Hazards Models medicine.diagnostic_test business.industry Proportional hazards model General Medicine Middle Aged Anterior Temporal Lobectomy medicine.disease Surgery Treatment Outcome Epilepsy Temporal Lobe Neurology Child Preschool Cohort Female Neurology (clinical) business 030217 neurology & neurosurgery Follow-Up Studies
Zdroj:	Acta Neurologica Scandinavica. 138:531-540
ISSN:	0001-6314
DOI:	10.1111/ane.13008
Popis:	Objectives To explore the effect of duration of epilepsy and delay in surgery on seizure outcome in patients operated for drug-resistant temporal lobe epilepsy (TLE). Materials & methods A total of 664 consecutive patients who underwent anterior temporal lobectomy (ATL) for TLE from 1995 to 2008 formed the study cohort. We divided them into two, one as seizure-free with or without antiepileptic drugs after ATL as "good outcome" (Engel class I a) and seizures of any type, any time after surgery as "poor outcome." The probability of seizure freedom/seizure recurrence based on the duration of epilepsy was compared using Kaplan-Meier curves, univariate Cox regression survival analysis, and multivariate Cox proportional hazards regression model. Results A total of 136 children and 528 adults underwent ATL during this period. Mean duration of epilepsy pre-ATL was 17.1 + 9.4 years. At mean follow-up of 8.5 years, 331 patients (49.8%) had good outcome and 333 (50.2%) had poor outcome. The hazard of seizure recurrence linearly increased with duration of epilepsy pre-ATL, from 1.5 (duration of epilepsy, 5-10 years) to 1.9 (duration of epilepsy, 10-15 years) to 2 (duration of epilepsy over 15 years). In addition, encephalitis as antecedent, bilateral mesial temporal sclerosis in MRI, normal histopathology, and spikes in postoperative EEG at 3 months and 1 year predicted poor seizure outcome. Conclusions "Epilepsy duration" independently predicted both short- and long-term seizure outcome after surgery in TLE. "Lost years" translate into poor seizure outcome after ATL. Therefore, all cases of drug-resistant TLE should be referred to a surgical center at the earliest.
Databáze:	OpenAIRE
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