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Predictors of surgical outcomes in patients with drug-resistant temporal lobe epilepsy


Aim. To identify predictors of surgical outcomes in patients with drug-resistant temporal lobe epilepsy in a multivariate model.

Materials and methods. Aretrospective study included 69 patients with drug-resistant temporal lobe epilepsy who underwent microsurgical anterior temporal lobectomy. The study included 31 (45%) men and 38 (55%) women. The median age was 28 (21; 36). Surgical treatment outcomes were assessed at 6, 12, 36, and 60 months after surgical intervention according to the Engel Epilepsy Surgery Outcome Scale. Logistic regression equations were calculated, a ROC curve was constructed, and odds ratio (OR) with 95% confidence interval (CI), sensitivity, specificity, area under the ROC curve (AUC) were calculated.

Results. In all assessed time periods, 88.3–93.0% of patients had outcomes consistent with Engel classes I and II. The distribution of patients by outcome classes did not change statistically significantly over the entire follow-up period. There were the following predictors of high efficacy of surgical treatment at 6 months after surgery: relatively shorter duration of active disease course (OR 0.719, 95%, CI: 0.437–0.966, p < 0.05), absence of status epilepticus (OR 0.048, 95% CI: 0.002–0.472, p < 0.05), absence of subdominant foci of irritative activity (OR 0.123, 95% CI: 0.012–0.845, p < 0.01), presence of mesial temporal sclerosis (OR 1008, 95% CI: 21.59–1310851, p < 0.01), a relatively longer resection margin on the temporal lobe (OR 637.32, 95% CI: 5.43–1960062, p < 0.05), lateralization of epileptogenic zone in subdominant hemisphere (OR 0.103, 95% CI 0.004–0.937, p = 0.0532). AUC was 0.957 (0.917–0.997), p < 0.0001; sensitivity 87.5%, and specificity 82.8%.

Conclusion. Independent predictors of the efficacy of microsurgical anterior temporal lobectomy in patients with drug-resistant temporal lobe epilepsy are the following: shorter duration of active disease course, absence of status epilepticus in the history, absence of subdominant foci, presence of mesial temporal sclerosis, a relatively longer resection margin on the temporal lobe, and lateralization of the epileptogenic zone in the temporal lobe of the subdominant hemisphere.

About the Authors

I. S. Shelyagin
Tyumen State Medical University; Federal Centre of Neurosurgery
Russian Federation

Ivan S. Shelyagin - Assistant Professor, Department of Pharmacology, Tyumen State Medical University; Neurosurgeon, Federal Centre of Neurosurgery.

54, Odessa str., Tyumen, 625023; 5, 4 km Chervishevskogo tract, Tyumen, 625032

Tel.: +7 (919) 954-53-81

P. O. Akimova
Federal Centre of Neurosurgery
Russian Federation

Polina O. Akimova - Neuropsychologist, Federal Center of Neurosurgery.

5, 4 km Chervishevskogo tract, Tyumen, 625032

S. Zh. Stefanov
Federal Centre of Neurosurgery
Russian Federation

Stefan Zh. Stefanov - Deputy Chief Medical Officer, Federal Center of Neurosurgery.

5, 4 km Chervishevskogo tract, Tyumen, 625032

R. A. Sufianov
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Rinat A. Sufianov - Assistant Professor, Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University).

8/2, Trubetskaya str., Moscow, 119991


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