Postoperative auras and the risk of recurrent seizures

Little is known about the prognostic significance of persistent auras following temporal lobe surgery in determining the recurrence of complex partial seizures (CPS) or generalized tonic-clonic seizures (GTCS).

In a retrospective analysis of temporal lobectomy patients who had preoperative auras associated with CPS or GTCS and who were seizure-free following surgery, the predictive value of auras was assessed at 3 months and 2 years following surgery. Medication use, in relation to the presence of auras, was also assessed.

Three hundred and forty-seven patients were seizure-free for 3 months following surgery (247 aura-free, 101 with persistent auras). KM analysis yielded no difference in outcome (p=0.65) and current outcome class was also similar (p=0.99). Patients with persistent auras were somewhat more likely to be on medication at the time of recurrence (p=0.06) and at last follow-up (p=0.09). 224 patients were seizure-free for 2 years following surgery (163 aura-free, 61 with persistent auras). KM analysis yielded no difference in outcome (p=0.86) and current outcome class was also similar (p=0.35). Patients with persistent auras were more likely to be on medication at the time of recurrence (p<0.001) and at last contact (p<0.01).

Auras were not associated with increased risk of recurrence, although increased rates of AED use were seen in these patients. However, any medication effect appears to be quite small, so we consider it reasonable to advise cessation of AEDs in patients with persistent auras who are otherwise seizure-free.