Title : Do classical semiology predict the post-operative outcome in patients with temporal lobe epilepsy?
Abstract:
Objective: TLE accounts for about 50-73% of cases being referred for epilepsy surgery. The objective is to find, whether the classical semiology in TLE has a role in predicting the post operative outcome in patients with refractory epilepsy.
Methods: We included 684 patients who underwent a detailed clinical evaluation, neuropsychological assessment, 1.5T/3T MRI, VEEG monitoring, followed by a standard anterior temporal lobectomy from 1995-2008.They were followed up at 3 months,12 months and yearly with EEG. The outcome was classified in to good, if they don’t have either seizure or aura irrespective of the drugs and as bad, even if single seizure occurred postoperatively
Results: Of the 684 patients, 93.7% had behavioral arrest; 88.6% had automatisms,86.7% had amnesia for the events,74.6% had auras and 63.6% had antecedents. All the classical semiology features were present in 37.7% of the whole cohort. 47.8% of the study population had good outcome till last follow-up. The mean follow up period was 75.6 months with a maximum follow up of 14 years. Cases with antecedents had lesser probability of seizures at last follow-up (p=0.009). Febrile seizures as a separate variable were found protective (p=0.021) and encephalitis was a risk factor(p=0.026). Behavioral Arrest was associated with poor seizure outcome following surgery(p=0.006). No significant association with outcome was found for the presence of auras, automatisms or amnesia. When the groups with typical and atypical semiologies were compared, we found no significant difference between the seizure outcome in any of the groups
Conclusion: The presence of antecedents, especially febrile seizures was associated with favorable surgical outcomes. The mere presence of auras, automatisms or amnesia does not affect outcome after TLE surgery. Arrest was associated with a worse outcome. Presence or absence of any combination of classical semiological features had no significant bearing on surgical outcome after anterior temporal lobectomy
Audience Take Away Notes:
- It helps to understand that, though the semiology features help in lateralizing and localizing the epilepsy it has no role in predicting the surgical outcome
- Rather giving much importance to semiology, a thorough evaluation with VEEG and Imaging will help us better delineate the pathology and that would bear effect on the surgical outcomes also
