OP-8 Postoperative Seizure Outcome in Anterior Temporal Lobectomy Surgeries for Mesial Temporal Sclerosis with and without Focal Cortical Dysplasia: An Experience from a Tertiary Care Center

Introduction: Although Mesial temporal sclerosis (MTS) is the commonest cause of temporal lobe epilepsy in adults, there is dearth of studies from India showing seizure outcomes and predictors of seizure freedom in these patients. We have tried to assess the impact of histopathologically proven focal cortical dysplasia (FCD) on postoperative seizure outcome in patients with MTS.

Inclusion and Exclusion Criteria: All histopathologically proven only MTS and MTS+FCD cases who were operated at our center between 2009 and 2012 without Electrocorticography guidance and followed up for at least 5 years were selected.

Methods: Retrospective observational study using archived duplicate files containing preoperative data and postoperative follow-ups.

Results: A total of 86 patients were operated for MTS. 65 followed up for at least 5 years. Histopathology was available for 43 patients. These were divided in two groups: MTS only (n = 21) and MTS + FCD (n = 22). Average age of onset of regular seizures was 15.44 ± 10.3 years for MTS only and 11.46 ± 10 years for MTS + FCD. At 1 year, Engel class IA Seizure outcome was seen in 100% in MTS only, while it was 81.81% in the MTS + FCD group. At 5 years, Engel class IA Seizure outcome was seen in 71.43% in MTS and 54.54% in MTS + FCD. Strongest predictors of seizure recurrence were bilateral lesions and postoperative residual hippocampus tail in the MTS only group and residual lesion in the MTS + FCD group.

Conclusion: Focal cortical dysplasia, bilateral mesial temporal sclerosis, and residual lesion are negative predictors of seizure freedom in mesial temporal sclerosis epilepsy surgery. MTS with FCD surgery is amenable to good seizure freedom if maintained on 1 to 2 antiseizure medication.

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Artikel online veröffentlicht:
12. September 2024