Do We Need EEGs After Temporal Lobe Epilepsy Surgery, and How Many?

نویسنده

  • Bassel W Abou-Khalil
چکیده

Commentary Mesial temporal lobe epilepsy with hippocampal sclerosis tends to be drug resistant but usually has excellent outcome with epilepsy surgery. Despite the excellent prognosis overall , a substantial proportion of patients are not seizure-free after surgery, and it is important to identify these patients before surgery, if possible. The few studies that have investigated outcome predictors for this specific patient group have found different predictors for short-term and long-term outcomes (1, 2). For example, secondarily generalized seizures and ictal dystonia were unfavorable predictors of outcome at 2 years, whereas longer epilepsy duration predicted surgical failure 5 years postoperatively (1). Preoperative factors are the most valuable for counseling patients so they could decide whether to proceed with surgery. However, post-operative predictors may be useful once surgery has taken place and may help guide patients with respect to actions/ activities that could increase the risk of seizure recurrence, such as antiepileptic drug (AED) withdrawal. Postoperative tests that have been investigated include postoperative elec-trocorticography, postoperative MRI, and postoperative EEG. In mesial temporal lobe epilepsy, postoperative electrocorti-cography has generally been unhelpful when recording from the lateral temporal cortex; however, there is a suggestion that recording from the stump of the hippocampus could be useful (3). The postoperative MRI is helpful for lesional epilepsy ; if the lesion has been incompletely removed, there is a greater chance of seizure recurrence after surgery than if the lesion has been removed in its entirety. The postoperative test most often studied is a routine EEG, usually a single EEG recording. With a few exceptions, most studies have found the postoperative EEG to be useful in predicting outcome. In a meta-analysis of published studies (and two unpublished data sets), the presence of interictal epileptiform discharges predicted an unfavorable seizure outcome, with an odds ratio of 2.5 for the subgroup of patients who underwent temporal resection (4). The featured study of Rathore and colleagues specifically evaluated the predictive value of serial postop-erative EEGs in patients with mesial temporal lobe epilepsy and hippocampal sclerosis followed for at least 5 years after surgery. The authors found that four postoperative EEGs were better than a single EEG at predicting postoperative seizure outcome in this patient group. Interestingly, postoperative EEGs were better at predicting seizure outcome for the last year of follow-up than in the entire follow-up period. Another study in patients with mesial temporal lobe epilepsy and hip-pocampal sclerosis found that preoperative …

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عنوان ژورنال:
  • Epilepsy currents

دوره 12 1  شماره 

صفحات  -

تاریخ انتشار 2012