دورية أكاديمية
Long-Term Outcome of Temporal Lobe Epilepsy Surgery in 621 Patients With Hippocampal Sclerosis: Clinical and Surgical Prognostic Factors.
| العنوان: | Long-Term Outcome of Temporal Lobe Epilepsy Surgery in 621 Patients With Hippocampal Sclerosis: Clinical and Surgical Prognostic Factors. |
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| المؤلفون: | Pereira Dalio MTR; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil., Velasco TR; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil., Feitosa IDF; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil., Assirati Junior JA; Department of Surgery and Neurosurgery, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil., Carlotti Junior CG; Department of Surgery and Neurosurgery, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil., Leite JP; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil., Dos Santos AC; Department of Radiology, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil., Alexandre V; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil., Nakano FN; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil., Saute RL; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil., Wichert-Ana L; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil., Sakamoto AC; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil. |
| المصدر: | Frontiers in neurology [Front Neurol] 2022 Apr 25; Vol. 13, pp. 833293. Date of Electronic Publication: 2022 Apr 25 (Print Publication: 2022). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Frontiers Research Foundation Country of Publication: Switzerland NLM ID: 101546899 Publication Model: eCollection Cited Medium: Print ISSN: 1664-2295 (Print) Linking ISSN: 16642295 NLM ISO Abbreviation: Front Neurol Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Original Publication: [Lausanne : Frontiers Research Foundation, 2010]- |
| مستخلص: | Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy and is frequently drug-resistant (DR) to antiseizure medication (ASM), corresponding to approximately one-third of the cases. When left inadequately treated, it can worsen the quality of life, cognitive deficits, and risk of death. The standard treatment for drug-resistant TLE is the surgical removal of the structures involved, with good long-term outcome rates of 60-70 % and a low rate of adverse effects. The goal of successful treatment is sustained seizure freedom. In our study, we evaluated sustained long-term (up to 23 years) surgical outcomes in 621 patients with DR-TLE associated with hippocampal sclerosis, who underwent a temporal lobectomy. We analyzed the main predictive factors that influence the surgical outcome related to seizure control, through a longitudinal and retrospective study, using a multivariable regression model. We found that 73.6% of the patients were free from disabling seizures (Engel Class I), maintained over time in 65% of patients followed up to 23 years after surgery. We found that four independent variables predicted seizure outcomes. The presence of dysmnesic and olfactory aura predicted a less favorable outcome. The history of febrile seizure and the surgical technique predicted a good outcome. Regarding the type of surgical technique, the standard anteromesial temporal lobectomy (ATL) led to significantly better outcomes (78.6% Engel Class I) when compared to the selective amygdalohippocampectomy via subtemporal approach (67.2% Engel Class I; p = 0.002), suggesting that the neuronal networks involved in the epileptogenic zone may be beyond mesial temporal structures. The multivariable regression model with the above-mentioned predictor variables revealed an ExpB = 3.627 ( N = 621, p < 0.001), indicating that the model was able to distinguish between patients with a seizure-free. We conclude that epilepsy surgery is a safe procedure, with low rates of postoperative complications and good long-term results. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Pereira Dalio, Velasco, Feitosa, Assirati Junior, Carlotti Junior, Leite, dos Santos, Alexandre, Nakano, Saute, Wichert-Ana and Sakamoto.) |
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| فهرسة مساهمة: | Keywords: epilepsy surgery; hippocampal sclerosis; long-term outcome; surgical outcome; surgical prognostic factors; temporal lobe epilepsy |
| تواريخ الأحداث: | Date Created: 20220513 Latest Revision: 20220716 |
| رمز التحديث: | 20231215 |
| مُعرف محوري في PubMed: | PMC9084624 |
| DOI: | 10.3389/fneur.2022.833293 |
| PMID: | 35547380 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1664-2295 |
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| DOI: | 10.3389/fneur.2022.833293 |