Abstracts

Majority of previous reports on the surgical outcome and its predictors in medically intractable epilepsy had focused on medial temporal lobe epilepsy. We performed this study to evaluate the postoperative outcome and the prognostic significances of clinical and demographic factors, results of presurgical evaluations, and pathologic findings in medically intractable neocortical epilepsy (NE).
Among the patients operatively managed between 1995 and 2001, 193 patients with NE (126 male, 67 female; age at surgery, 26.7 [plusmn] 7.8 years) and sufficient postoperative follow-up (more than one year) were included. The primary outcome variable was the status of patients in the last postoperative year, classified as either seizure free or not free. Demographic, clinical, electroencephalographic, MRI, PET, SPECT and pathologic data were analyzed.
One hundred eleven (57.5 %) patients were free of seizure. Multifocal ictal onset (p = 0.001), extratemporal ictal focus (p = 0.003), absence of epileptogenic lesion on MRI (p = 0.003), non-localized ictal onset pattern on scalp EEG (p = 0.02), non-localizable finding in PET (p = 0.003), and pathologic diagnosis as malformations of cortical development predicts poor surgical outcome with univariate analysis. By using multivariate analysis, the findings of MRI, PET, and ictal scalp EEG were the significant predictors of surgical outcome.
Moderate proportions of surgically remedied NE patients remained seizure-free. Presence of epileptogenic lesion on MRI, and localizing patterns in PET and ictal scalp EEG are factors associated with good postsurgical outcome.