Acute postoperative seizures and long-term seizure outcome after surgery for hippocampal sclerosis. (January 2015) - Di Gennaro, Giancarlo
Highlights: Acute postoperative seizures (APOS) are relatively uncommon after surgery for temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS). The occurrence of APOS in patients who had TL resection for HS is associated with worse long-term seizure outcome. Greater caution may be required when attempting antiepileptic drugs withdrawal in patients who experienced APOS. Abstract: Purpose: To assess the incidence and the prognostic value of acute postoperative seizures (APOS) in patients surgically treated for drug-resistant temporal lobe epilepsy due to hippocampal sclerosis (TLE-HS). Methods: We studied 139 consecutive patients with TLE-HS who underwent epilepsy surgery and were followed up for at least 5 years (mean duration of follow-up 9.1 years, range 5–15). Medical charts were reviewed to identify APOS, defined as ictal events with the exception of auras occurring within the first 7 days after surgery. Seizure outcome was determined at annual intervals. Patients who were in Engel Class Ia at the last contact were classified as having a favorable outcome. Results: Seizure outcome was favorable in 99 patients (71%). Six patients (4%) experienced APOS and in all cases their clinical manifestations were similar to the habitual preoperative seizures. All patients with APOS had unfavorable long-term outcome, as compared with 35 (26%) of 133 in whom APOS did not occur ( p < 0.001). Conclusions: Our study suggests that APOS, despite being relatively uncommon in patients undergoing resective surgery for TLE-HS, are associated with a worse long-term seizure outcome. Given some study limitations, our findings should be regarded as preliminary and need confirmation from future larger, prospective, multicenter studies.