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Remote preoperative tonic-clonic seizures do not influence outcome after surgery for temporal lobe epilepsy
Journal article   Open access   Peer reviewed

Remote preoperative tonic-clonic seizures do not influence outcome after surgery for temporal lobe epilepsy

Ali A. Asadi-Pooya, Amin H. Rabiei, Edward J. Gracely and Michael R. Sperling
Journal of the neurological sciences, v 369, pp 330-332
15 Oct 2016
DOI: https://doi.org/10.1016/j.jns.2016.09.001
PMID: 27653919
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1121&context=neurologyfpView
SubmittedCC BY-NC-ND V4.0,  Open

Abstract

Clinical Neurology Life Sciences & Biomedicine Neurosciences Neurosciences & Neurology Science & Technology
Objectives: Tonic-clonic seizures are associated with greater chance of seizure relapse after anterior temporal lobectomy. We investigated whether the interval between the last preoperative tonic-clonic seizure and surgery relates to seizure outcome in patients with drug-resistant mesial temporal lobe epilepsy (MTLE). Methods: In this retrospective study, patients were prospectively registered in a database from 1986 through 2014. Postsurgical outcome was categorized as seizure freedom or relapse. The relationship between surgical outcome and the interval between the last preoperative tonic-clonic seizure and surgery was investigated. Results: One-hundred seventy-one patients were studied. Seventy nine (46.2%) patients experienced tonic-clonic seizures before surgery. Receiver operating characteristic curve of timing of the last preoperative tonic-clonic seizure was a moderate indicator to anticipate surgery failure (area under the curve: 0.657, significance; 0.016). The best cutoff that maximizes sensitivity and specificity was 27 months; with a sensitivity of 0.76 and specificity of 0.60. Cox-Mantel analysis confirmed that the chance of becoming free of seizures after surgery in patients with no or remote history of preoperative tonic-clonic seizures was significantly higher compared with patients with a recent history (i.e., in 27 months before surgery) (p = 0.0001). Conclusions: The more remote the occurrence of preoperative tonic-clonic seizures, the better the postsurgical seizure outcome, with at least a two year gap being more favorable. A recent history of tonic-clonic seizures in a patient with MILE may reflect more widespread epileptogenicity extending beyond the borders of mesial temporal structures. (C) 2016 Elsevier B.V. All rights reserved.

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Collaboration types
Domestic collaboration
Web of Science research areas
Clinical Neurology
Neurosciences
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