Factors influencing the long-term prognosis of patients with temporal lobe epilepsy: a single center study.

Abstract

This study aimed to explore the risk factors influencing the long-term prognosis of temporal lobe epilepsy (TLE) patients treated with drug therapy or surgical treatment. A total of 112 patients who were diagnosed with TLE were retrospectively enrolled. All of the patients were initially treated with antiepileptic drugs (AEDs). Patients who met the criteria of drugresistant TLE were evaluated for treatment with temporal lobectomy. The main outcome was whether the patients achieved seizure-free status. This was defined as when a patient experienced no seizures for at least 24 months of follow-up. The independent predictors of the outcome were evaluated using a multiple logistic regression model. The median follow-up period was 5 years (range, 2-13 years). At the end of follow-up, 26 patients had not achieved seizure freedom after treatment with AEDs, including 22 cases of monotherapy, 4 cases of duotherapy (1 case of drug-resistant epilepsy after continuous drug treatment). AED treatment was withdrawn in 6 patients. Overall, 23.2% TLE patients (26/112) achieved seizure freedom after treatment with AEDs alone, while the remaining 76.8% (86/112) of patients were diagnosed as drug-resistant epilepsy (DRE). Of the 45 DRE patients who subsequently received surgical treatment, 77.8% (35/45) achieved seizure freedom, with successful AED withdrawal in 11 patients. The proportion of patients who achieved seizure-free status was higher among those who underwent temporal lobectomy than among those who continued with AED treatment (77.8% vs. 23.2%, P<0.001). Effective early monotherapy was an independent predictor for good therapeutic effect in all TLE patients (OR: 0.16; 95% CI: 0.04-0.66; P=0.007). Multivariate logistic regression analysis showed the predictors of good prognosis in DRE patients after surgery to be unilateral origin of discharges in electroencephalogram (EEG, OR =0.20, 95% CI: 0.06-0.74, P=0.016), no secondary generalized tonic-clonic seizures (GTCS, OR =0.08, 95% CI: 0.01-0.67, P=0.002), and not needing a subdural electrode (OR =15.4, 95% CI: 1.36-174.38, P=0.027). Effective early monotherapy was an independent protective factor for the favorable prognosis of TLE. Unilateral origin of discharges in EEG, no secondary GTCS, and not needing a subdural electrode were independent factors associated with favorable prognosis after TLE surgery.