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Acta Neurochir (Wien). 2017 May;159(5):757-766. doi: 10.1007/s00701-017-3127-y. Epub 2017 Mar 9.

Seizure outcomes of temporal lobe epilepsy surgery in patients with normal MRI and without specific histopathology.

Author information

1
Department of Neurosurgery, Oslo University Hospital, Sognsvannsveien 20, N-0027, Oslo, Norway. jugiva@ous-hf.no.
2
Clinical Neurophysiologic Laboratory, Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
3
Department of Clinical Psychology and Neuropsychology, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway.
4
Department of Radiology, Oslo University Hospital, Oslo, Norway.
5
Department of Pathology, Oslo University Hospital, Oslo, Norway.
6
Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
7
Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
8
Oslo Centre for Biostatistics and Epidemiology, Research Support Service, Oslo University Hospital, Oslo, Norway.
9
Department of Adult Epilepsy, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway.
10
Department of Neurosurgery, Oslo University Hospital, Sognsvannsveien 20, N-0027, Oslo, Norway.

Abstract

BACKGROUND:

Seizure outcome following surgery in pharmacoresistant temporal lobe epilepsy patients with normal magnetic resonance imaging and normal or non-specific histopathology is not sufficiently presented in the literature.

METHODS:

In a retrospective design, we reviewed data of 263 patients who had undergone temporal lobe epilepsy surgery and identified 26 (9.9%) who met the inclusion criteria. Seizure outcomes were determined at 2-year follow-up. Potential predictors of Engel class I (satisfactory outcome) were identified by logistic regression analyses.

RESULTS:

Engel class I outcome was achieved in 61.5% of patients, 50% being completely seizure free (Engel class IA outcome). The strongest predictors of satisfactory outcome were typical ictal seizure semiology (p = 0.048) and localised ictal discharges on scalp EEG (p = 0.036).

CONCLUSION:

Surgery might be an effective treatment choice for the majority of these patients, although outcomes are less favourable than in patients with magnetic resonance imaging-defined lesional temporal lobe epilepsy. Typical ictal seizure semiology and localised ictal discharges on scalp EEG were predictors of Engel class I outcome.

KEYWORDS:

Epilepsy surgery; Normal MRI; Normal or non-specific histopathology; Postsurgical seizure outcomes; Prognostic factors; Temporal lobe epilepsy

PMID:
28281007
PMCID:
PMC5385196
DOI:
10.1007/s00701-017-3127-y
[Indexed for MEDLINE]
Free PMC Article

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