Analysis of surgical efficacy and prognostic factors in temporal lobe epilepsy patients with hippocampal sclerosis and temporal lobe neocortical lesions
Objective To explore the surgical efficacy and prognostic factors in temporal lobe epilepsy(TLE)patients with hippocampal sclerosis combined with temporal lobe neocortical lesions.Methods The clinical data of 62 TLE patients who underwent anterior temporal lobe resection for hippocampal sclerosis combined with temporal lobe neocortical lesions at the Department of Neurosurgery,Xiangya Hospital,Central South University from January 2014 to April 2018 were retrospectively collected.Patients were followed up 3 months after surgery and every year by outpatient or telephone interviews.The surgical efficacy was graded according to the International League Against Epilepsy(ILAE)epilepsy surgery outcome standards and divided into a favored outcome group(favored group)and an unfavored outcome group(unfavored group).Univariate and multivariate logistic regression analyses were used to evaluate factors that may affect the surgical efficacy.Variables with P＜0.05 in the univariate analysis were included in multivariate analysis to determine the risk factors for unfavored postoperative outcome.According to the postoperative pathology type,the patients were divided into focal cortical dysplasia(FCD)Ⅲ a(hippocampal sclerosis combined with temporal lobe neocortex FCD type Ⅰ)group and dual pathology(hippocampal sclerosis combined with other pathological lesions)group.The differences in clinical characteristics and surgical efficacy of patients with different pathology types were analyzed.Results Postoperative pathology confirmed that 43 patients(69.35％)had FCD type Ⅲa;19 patients(30.65％)had dual pathology.The operations of 62 patients were successfully completed,and 6 patients(9.68％)experienced postoperative complications,including 1 case of intracranial hemorrhage,1 case of subarachnoid hemorrhage,1 case of intracranial infection,1 case of mild hemiplegia,1 case of mania,and 1 case of persistent mild aphasia.At 3 months post surgery,50 patients(80.65％)had no seizures or had aura of epilepsy;12 patients(19.35％)still had epileptic seizures after surgery.All 62 patients received clinical follow-up,and the follow-up time was 3.37±0.94 years.By the last follow-up,49 patients(79.00％)had no epileptic seizures after surgery,including 46 patients with ILAE grade 1 outcome and 3 patients with grade 2 outcome;13 patients still had epileptic seizures after surgery,including 3 cases of ILAE grade 3,6 cases of grade 4,3 cases of grade 5,and 1 case of grade 6.The results of univariate analysis showed that the differences in age at surgery,side of the lesion,and interictal epileptiform discharges(IEDs)between the postoperative favored outcome group and unfavored outcome group were statistically significant(all P＜0.05);while there were no statistically significant differences in gender,disease course or age of onset(all P＞0.05).Multivariate analysis results showed that existence of bilateral IEDs was a risk factor for unfavored postoperative outcome(OR=8.57,95％CI:1.62-45.40,P=0.012).Compared with the dual pathology group,the patients in the FCD Ⅲa group were older at surgery and had a longer course of disease,and the differences were statistically significant(both P＜0.05).However,there was no statistically significant difference in the postoperative efficacy between the two groups(P＞0.05).Conclusions Surgical resection is an effective way to treat TLE patients with hippocampal sclerosis and temporal lobe neocortex lesions.Existence of bilateral IEDs is a risk factor for poor surgical efficacy.Although there are differences in clinical characteristics between patients with FCD type Ⅲ a and dual pathology,the surgical outcomes are similar between the two groups.
Epilepsy,temporal lobeMalformations of cortical development,group ⅢTreat-ment outcomeRoot cause analysisHippocampal sclerosisDual pathology
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