The Prediction On The Long-term Effects Of Patients With Acute Postoperative Seizure After Surgery With Intractable Temporal Lobe Epilepsy

objective: To study the clinical characteristics,possible causes of acute postoperative seizure,surgical procedure and postoperative outcomes of patients with acute postoperative seizure after surgery with intractable temporal lobe epilepsy.Methods : Fifty two patients who accepted surgical treatment in the Neurosurgery Department of Southwest Medical University affiliated 363 hospital from June 2009 to June 2010 were involved in this study.All patients have Postoperative regular follow-up of all patients.The follow-up data including of case history and symptom features ? surgical programs,and information of more than five years of outpatient follow-up or phone visiting.All patients were performed surgery and all had a series of preoperative examinations by.15 T MRI,24 hours long-term video electroencephalogram monitoring(24h V/EEG) positioning epileptic area.All patients assessed by neurosurgery,neurology,electrophysiology,neuropathology,and neuropsychology experts decide to surgery or not.Intraoperative cortical EEG monitoring was repeated used to describe the epileptic zone and extent of surgical resection.In order not to cause nerve dysfunction and under the guidance of minimally invasive neurosurgery,using kinds of surgical procedure to cut the lesions as thoroughly as possible.Surgical procedures includedanterior temporal lobectomy+medial temporal lobe resection?extra-temporal lobe resection?electro-coagulation on cerebral cortexes?multiple subarachnoid transections and the like.When intra operative monitoring showed abnormal discharge restricted to temporal lobe choosing anterior temporal lobectomy.Considering some patients epileptic zone located in medial temporal lobe,intraoperative monitoring showed epileptic foci spreading to the temporal lobe,performing anterior temporal lobectomy+medial structure resection;If monitoring showed that epileptic foci was beyond the boundary of the temporal lobe,spreading to the frontal pole ? parietal lobe,removed temporal lobe epileptic foci and extra-temporal lobe epileptic foci;When lesion extended to brain's motor areas using intraoperative function monitoring or inraoperative wake-up technology to determine the motor areas,anterior temporal lobectomy+electro-coagulation on cerebral cortexes or ormultiple subarachnoid transections were performed.Intraoperative cortical EEG was repeated used to monitor the surgical site until the waveforms changed to normal.Then,the operation was over.All pathological specimens after operation checked by pathology department regularly.The patients,who underwent operation,were asked to go to epilepsy center in our hospital to adjust the dosage for individual administration.According to the relapse situation one week after surgery,these patients were divided into experimental group(relapse)and control group(without relapse).Long-term efficacy,follow-up data between two groups were analyzed,according to Engel classification.All data were analyzed by SPSS21.0 software for statistical analysis,measurement data using analysis oft-test and calculators information using chi-square test.The risk factor of long-term outcome was analyzed by logistic regression.Kaplan-Meier survival analysis was used to compared the remission rate between two groups.P<0.05 was considered to be statistically significant.Results:52 patients were included in the study,20 patients were in the experimental group,32 patients were in the control group.14 patients' results according to the pathology had no found,10/14 belonged to experimental group,relapse rate higher than other pathologic types;patients who had tumors,relapse rate lower the most.Checking by the chi-square test,all pathologic types were no difference(P>0.05).46/52 patients had at least one seizure during the follow-up period,43.5% relapsing in the first 7 days and 56.5% relapsing later than one week or longer.Based on Engel classification,controls had better long-term prognosis than the other group(P=0.017,P<0.05).Patients who had more than 3 AEDs before surgery treament,had a worse prognosis(P=0.028,P<0.05).Postoperative EEG examination,which had a poor outcome,in 3 months seemed to have a poor prognosis.(P=0.006,P<0.05).Kaplan-Meier survival analysis point that controls' remission rate always higher than the other during follow-up period(P=0.032,P<0.05).Multivariate Logistic regression analysis showed that risk factors affecting the long-term outcome included relapse times more than 3times,using ?3 AEDs prior to surgery,pathological postoperative EEG and APOS similar to habitual seizures. Conclusion : Intractable temporal lobe epilepsy with APOS after surgery will affect its long-term outcome,and the determinate factors included relapse times ?3 times,using ?3 AEDs prior tosurgery,pathological postoperative EEG and APOS similar to habitual seizures.A follow-up system is necessary for who have intractable temporal lobe epilepsy,it can give advise to adjust AEDs and reduce the damage of brain as far as possible.While,patient who is suit to accept reoperation,do it earlier.