Long-term Prognosis Of Surgery For Intractable Temporal Lobe Epilepsy And Its Affecting Factors

Objective:To analysis the long term efficacy of temporal lobe epilepsy surgery and to evaluate preoperative factors predicting a good postoperative outcome on long-term follow-up.Methods:We performed a retrospective consecutive analysis of patients who underwent operation because of medically intractable epilepsy at our institution from 2005 to 2008.92 patients were included, there were 31 female(33.70%) and 61 male (66.30%) patients. The mean age of the patients at surgery was 22.88±12.11 years, and the mean age at seizure onset was 15.52±10.36 years. The mean duration of epilepsy was 7.36±6.13 years. The preceding values were given as the mean±standard deviation. Seizure outcome was classified according to Engel's classification. Retrospective data were analysed using s multivariate logistic regression.Result:Rates of seizure freedom were 45.65%,57.61%,54.35% and rates of EngleⅠ+Ⅱwere 71.74%,84.78%,81.52% at 6 months,1 and 3 years.Outcome at one year was better than the short term outcome. The good outcome was related to hippocampal sclerosis and focal EEG discharge(P< 0.05),unrelated to age of seizure onset,duration of epilepsy,age at surgery, seizure types,frequency,site of resection or acute attact.Conclusion:Patients with temporal lobe epilepsy have satisfying surgical outcomes, particularly when hippocampal sclerosis or focal EEG discharge is present. The results of this study suggest that temporal lobe surgery has real long-term benefits,even increases risk of recurrence.This finding may have important implications for patient counseling and postoperative discontinuation of anticonvulsant medications. Objective:Epilepsy surgery is a valuable treatment option for patients with intractable epilepsy,but seizure freedom is often achieved at the cost of cognitive impairments caused by surgery.The aim of this study was to assess cognitive outcome following surgery for intractable temporal lobe epilepsy.Methods:We conducted a prospective study on the patients undergoing epilepsy surgery for intractable temporal lobe epilepsy between 2008 and 2010 at our institution.Cognitive was assessed before surgery and within 12 months after surgery. Cognitive was assessed using Wechsler Intelligence Scale(WIS) and seizure outcome using Engle grading.Results:Patients who underwent left temporal surgery had significant decline in verbal intelligence quotient(VIQ) (89.11±13.94&82.37±13.66,P<0.05). Performance intelligence quotient(PIQ) improvement seemed to occur in patients with good seizure outcome (P=0.001＜0.05)and in children irrespective of seizure outcome(P=0.028).VIQ and full-scale intelligence quotient(FIQ) decreased in adult patients after surgery for intractable epilepsy(P=0.012,P=0.027).Pathology had no significant influence on cognitive scores except that VIQ declined in the group of none-hippocampus sclerosis.Conclusion:The cognitive outcome does not change dramatically after surgery, on the contrary,children and patients with good outcome can benefit from surgery. Objective:To investigate health-related quality of life (HRQOL) outcome in adults with intractable temporal lobe epilepsy (TLE) surgery,comparing QOL before and after surgery.Methods:we conducted a prospective study on patients undergoing epilepsy surgery.HRQOL as measured by the the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) was evaluated before surgery,within 6 months,and 12 months after surgery.Seizure outcome was assessed using Engle grading.Patients were split into two groups according to surgery outcome:good outcome group and poor outcome group.Results:At the 6-month follow-up, there was very significant improvement in all the domains of QOLIE-31 in the good outcome group after surgery(P<0.05),HRQOL improvement was seen in all the domains in the poor outcome group except medication effects (P=0.255>0.05).Improvement in seizure worry,emotional wellbeing,social functioning and overall HRQOL was significantly more in the good outcome group.At the 12-month follow-up, HRQOL continued to improve in the good outcome group and kept stable in the poor outcome group.Conclusion:After temporal resection, HRQOL improves in the good outcome group,HRQOL in the poor outcome group keeps stable. These results may be useful in presurgical counseling and identifying patients at risk for poor psychosocial outcome following surgery.