Outcomes after temporal lobectomy for temporal lobe epilepsy with hippocampal sclerosis.

OBJECTIVE: Outcome predictors from the pure cohorts of patients with temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS) are limited The aim of the present study was to assess seizure outcomes and predictive factors in groups of well-defined patients with TLE-HS. MATERIAL AND METHOD: One hundred forty eight patients with drug resistant TLE who had magnetic resonance imaging (MRI) that demonstrated unilateral HS underwent temporal lobectomy between 2004 and 2008 by a single neurosurgeon. All patients had completed at least two years of follow-up. Seizure outcome was categorized into seizure-free and not seizure-free. RESULTS: Ninety-five patients (64.2%) were seizure-free after surgery at two years of follow-up. At four years follow-up, 47 patients (77.1%) were seizure-free for at least two years. There was no operative mortality or significant morbidity. No clinical variables are predictive of surgical outcomes at two and four years offollow-up. CONCLUSION: Temporal lobectomy for drug-resistant TLE with HS is safe and effective. The authors did not identify predictive factors of surgical outcomes in TLE-HS.

Outcome of temporal lobectomy for hippocampal sclerosis in older patients.

Patients of 50 years or older account for a small but significant portion of the patient population that receives surgical treatment for epilepsy. There have been few studies reporting surgical outcomes from temporal lobectomy in older patients. We examined seizure outcome and surgical complications after anterior temporal lobectomy for temporal lobe epilepsy with pathological evidence of unilateral hippocampal sclerosis. Two patient groups were compared in this study: patients 50 years or older (mean age 55.5 years old, n=16) and patients less than 50 years old (mean age 32.9 years old, n=184). After a minimum of one year follow up, younger patients (79.4%, n=146) were significantly more likely to be seizure-free (p=0.041) compared to older patients (56.3%, n=9). There was no significant difference (p=0.404) between the two age groups in the percentage of patients withdrawn from medication following surgery. Surgical complications were significantly higher in the older age group compared to the younger age group (p=0.009), although there was no permanent morbidity. Thus, while surgical treatment of temporal lobe epilepsy with unilateral hippocampal sclerosis is still beneficial in older patients who are refractory to medical therapy, surgical treatment should be considered at as early an age as possible, to maximize the chance for a better outcome with fewer complications.