Giancarlo Di Gennaro1, Sara Casciato2, Alfredo D'Aniello3, Marco De Risi3, Pier Paolo Quarato3, Addolorata Mascia3, Liliana G Grammaldo3, Giulio N Meldolesi4, Vincenzo Esposito5, Angelo Picardi6. 1. IRCCS "NEUROMED", Pozzilli (IS), Italy. Electronic address: gdigennaro@neuromed.it. 2. Department of Neurology and Psychiatry, "Sapienza University of Rome", Italy. 3. IRCCS "NEUROMED", Pozzilli (IS), Italy. 4. 'Neurone' Foundation for Research in Neuropsychobiology and Clinical Neurosciences, Rome, Italy. 5. IRCCS "NEUROMED", Pozzilli (IS), Italy; Department of Neurosurgery, "Sapienza University of Rome", Italy. 6. Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy.
Abstract
OBJECTIVE: To test if postoperative prolonged awake and sleep EEG monitoring predict long-term seizure outcome in patients operated for drug-resistant temporal lobe epilepsy due to hippocampal sclerosis (TLE-HS). METHODS: This longitudinal study includes 107 patients with MTLE-HS who underwent anterior temporal lobectomy (ATL), were followed for at least 5 years (mean 8.3, range 5-12), had postoperative EEG after 2 months and at least one prolonged video-EEG monitoring during both wakefulness and sleep after 12 and 24 months. At each follow-up visit, the presence of interictal epileptiform discharges (IED) was determined, and seizure outcome was evaluated. RESULTS: Sixty-six patients (62%) remained free from auras and seizures throughout the follow-up period. Twenty-six (24%), 22 (21%), and 16 (16%) patients had IED at the 2-month, 12-month, and 24-month follow-up, respectively. The presence of IED at each time point was found to be associated with seizure or aura recurrence. Sleep recording contributed to the identification of patients with IED, as half of patients with IED displayed anomalies in sleep EEG only. In multivariate analysis, the presence of IED 2 months after surgery was found to be associated with seizure or aura recurrence independent of pre-operative factors consistently reported as outcome predictors in the literature. CONCLUSIONS: The presence of IED in serial postoperative EEG including sleep recording may predict long-term seizure outcome after ATL for TLE-HS. Serial postoperative EEGs may contribute to outcome prediction and help making decision about medication withdrawal in patients operated for TLE-HS.
OBJECTIVE: To test if postoperative prolonged awake and sleep EEG monitoring predict long-term seizure outcome in patients operated for drug-resistant temporal lobe epilepsy due to hippocampal sclerosis (TLE-HS). METHODS: This longitudinal study includes 107 patients with MTLE-HS who underwent anterior temporal lobectomy (ATL), were followed for at least 5 years (mean 8.3, range 5-12), had postoperative EEG after 2 months and at least one prolonged video-EEG monitoring during both wakefulness and sleep after 12 and 24 months. At each follow-up visit, the presence of interictal epileptiform discharges (IED) was determined, and seizure outcome was evaluated. RESULTS: Sixty-six patients (62%) remained free from auras and seizures throughout the follow-up period. Twenty-six (24%), 22 (21%), and 16 (16%) patients had IED at the 2-month, 12-month, and 24-month follow-up, respectively. The presence of IED at each time point was found to be associated with seizure or aura recurrence. Sleep recording contributed to the identification of patients with IED, as half of patients with IED displayed anomalies in sleep EEG only. In multivariate analysis, the presence of IED 2 months after surgery was found to be associated with seizure or aura recurrence independent of pre-operative factors consistently reported as outcome predictors in the literature. CONCLUSIONS: The presence of IED in serial postoperative EEG including sleep recording may predict long-term seizure outcome after ATL for TLE-HS. Serial postoperative EEGs may contribute to outcome prediction and help making decision about medication withdrawal in patients operated for TLE-HS.
Authors: Midhun Mohan; Simon Keller; Andrew Nicolson; Shubhabrata Biswas; David Smith; Jibril Osman Farah; Paul Eldridge; Udo Wieshmann Journal: PLoS One Date: 2018-05-16 Impact factor: 3.240