Introduction: Mesial temporal lobe epilepsy is the most common cause of refractory epilepsy in adults. In these patients selective or non-selective amygdalohippocampectomy can lead to seizure freedom in 62-70% of cases. However, the prognostic factors determining seizure outcome are still debatable. The purpose of this study was to identify the pre and post operative factors that are independent predictors of seizure outcome of patients who underwent non-selective amygaladohippocampectomy in Epilepsy Surgery Group from Centro Hospitalar de Lisboa Ocidental.
Methods: Case-control study of the patients who underwent non-selective amygdalohippocampectomy, in our center, between 1997 and 2015. Patients were divided in two groups according do Engel classification- seizure free (Engel class I) and non seizure free (Engel Classes II- IV). Univariate analysis was performed to analyse the potential prognosis predictors, including demographic characteristics, epilepsy history, imaging findings, pathology results and post surgical data.
Results: During this period 119 patients underwent non-selective amygdalohippocampectomy. After an average 9 years follow-up (range 1-18 years) 91 patients (76%) were seizure-free and 28 patients (24%) were non seizure free – 18 patients Engel Class II, 7 patients Engel Class III and 3 patients Engel Class IV. In univariate analysis 4 factors were associated with non-seizure free outcome: date of surgery before 2005 (p=0,02), negative MRi (p=0,02), major surgical complications (p=0,0001, OR 13.04) and seizures in early post-operative period (p=0,032). No significant differences were found in gender, age at time of surgery, epilepsy duration, surgery side and epilepsy history.
Conclusions: In our series, negative pre-operative MRi, epilepsy group low experience, major surgical complications and seizures in early post-operative period were associated with higher risk of non seizure-freedom after non-selective amygdalohippocampectomy.
Patient Care: Allowing the surgeons to identify patients who are at higher risk of non-seizure freedom after non selective amigdalo-hipocampectomy.
Learning Objectives: By the conclusion of this session the participants should be able to identify some factors associated with non seizure freedom after non selective amigdalo-hipocampectomy.