Prognostic factors for temporal lobe epilepsy surgery in a tertiary center

Temporal lobe epilepsy (TLE) represents the most common type of partial epilepsy. Early age of onset, a history of febrile convulsions, epileptiform discharges on electroencephalography, duration of epilepsy, number of generalized seizures and severity of psychiatric disorders are possible prognostic factors in patients with mesial temporal sclerosis. The aim of this study is to review the findings of clinical research, semiotic, psychological, electrophysiological and neuroradiological, and to relate these findings with the prognosis of patients with TLE who underwent anteromedial temporal lobectomy (ATL).

Of 1214 patients evaluated for surgery in the epilepsy Center of the São Jose do Rio Preto Faculty of Medicine (Faculdade de Medicina de São José do Rio Preto - FAMERP), a tertiary Brazilian epilepsy center, 459 underwent ATL for TLE. Exams and clinical data were analyzed and compared with Engel classification for outcome.

Of all the items analyzed, the MRI showed a greater influence on the outcome of patients and for clinical evaluation and pathological antecedents, age at surgery, the epilepsy duration, seizure frequency, mesial temporal sclerosis, dysplasia, perinatal insults, vascular insults, a family history of epilepsy, febrile seizures, neuropsychological abnormalities and presence of generalized tonic-clonic seizure has a statistical significance.

In order to identify the most appropriate candidates for ATL, it is very important to consider the prognostic factors associated with favorable for counseling patients in daily practice.