Abstracts

RATIONALE: Mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) is the main type of surgically treatable epilepsy syndrome. There are many reports analyzing seizure outcome after temporal lobectomy, however larger series with long-term follow-up generally included pre-MRI and post-MRI cases which may have led to the inclusion of non-HS cases, while more recent series usually comprise small number of cases and/or short-term follow-up. Presurgical predictors of outcome is essential for patient and family counseling. In this report we analyzed a large and homogeneous group of pathologically confirmed HS-MTLE and address specifically the possibility of presurgical predictors of seizure outcome.
METHODS: 207 consecutive HS-MTLE patients, 101 males and 106 females, were operated from 1994 to 2000. Post-surgical follow-up ranged from 2 to 7 years. Duration of epilepsy ranged from 4 to 46 years. All patients were submitted to standardized presurgical evaluation which included clinical history, MRI, Video-EEG monitoring, and neuropsychological testing. Ictal SPECT was obtained for most cases and Wada Test whenever necessary. We analyzed history of febrile convulsion or initial precipitating injury, family history of epilepsy and febrile convulsion, age, sex, age at onset, age at surgery, side of surgery, duration of epilepsy, IQ, etiology, frequency of seizures, EEG and seizure outcome according to Engel Classification schema.
RESULTS: Age at onset varied from 5 to 57 years old, and duration of epilepsy ranged from 4 to 46 years. IQ varied from 48 to 120. Seizure outcome disclosed 171 (82%) patients classified as Engel Class I, 20 (10%) patients as Engel Class II, 12 (6%) patients as Engel Class III, and 4 (2%) patients as Engel Class IV
CONCLUSIONS: No presurgical data were predictive of post-surgical seizure outcome in this study.
[Supported by: FAEPA, CNPq and FAPESP.]