Different Outcomes of Intractable Temporal Lobe Epilepsy with Regard to the Timing of Surgical Intervention

Kook, Jin Hwa; Choi, Bong Seok; Kang, Ji Seon; Woo, Young Jong; Lee, Min Chol; Kim, Hyung Il

Abstract

PURPOSE: We like to examine the clinicopathologic findings of intractable temporal lobe epileptic patients who underwent epilepsy surgery, and different outcomes with regard to the timing of surgical intervention.
METHODS
One hundred fourty six patients underwent anterior temporal lobectomy for medically intractable epilepsy between the year of 1993 and 2000. Except 5 patients who had malignancy, 132 patients were included in this study and were followed up for longer than 12 months after surgery. Two groups, under 15 years old(pediatric group) and over(adult group) according to the timing of surgery, were compared with clinical variables(seizure patterns, EEGs and brain MRI findings), pathologic findings and seizure outcomes. Seizure outcomes were divided as favorable in Class I and II or unfavorable in Class III and IV by using Engel's classification.
RESULTS
Among 132 patients, 103 patients(78.0%) were classified as favorable and 29 patients(22.0%) unfavorable. Adult group had more favorable outcomes than pediatric group(82.1% vs 55.0%, P=0.007). Pathologic findings were as follows:48 patients(36.4%) had only hippocampal sclerosis, 50(37.9%) hippocampal sclerosis with other pathologic findings, 20(15.2%) cortical dysplasia, 6(4.5%) cortical dysplasia and gliosis, 7(5.3%) only gliosis and 1(0.7%) hippocampal atrophy. Among 98 patients who had hippocampal sclerosis, 81(82.7%) had favorable outcomes. Among 26 patients who had cortical dysplasia, 16(61.5%) had favorable outcomes. In case of hippocampal sclerosis only, pediatric group had more favorable outcomes(85.7% vs 82.9%, P=0.86). But in case of hippocampal sclerosis with other pathologic findings, adult group had more favorable outcomes(50.0% vs 86.4%). In case of cortical dysplasia only, adult group had more favorable outcomes(40.0 % vs 74.3%).
CONCLUSION
The seizure outcomes after surgery, pediatric group showed less favorable outcomes than adult group. In case of hippocampal sclerosis only, the outcome of early surgery was good too.