Long-term Remission and Resolution of Epilepsy following Surgery for Drug Resistant Lesional Temporal Lobe Epilepsy. (P2-1.001)

Abstract

<h3>Objective:</h3> To determine the long-term seizure freedom and resolution of epilepsy in patients with drug resistant Temporal Lobe Epilepsy (TLE) and a clear-cut MRI lesion. <h3>Background:</h3> The long-term seizure free outcomes following surgery for TLE varied widely from 41% – 80% following surgery for TLE. <h3>Design/Methods:</h3> In a retrospective, longitudinal cohort study, we analysed the presurgical, surgical and post-surgical parameters to determine the seizure freedom and resolution of epilepsy in patients with ‘drug resistant lesional TLE with at least 10 years or more of post-surgery follow-up. The Study period was from June 2001 to 2012 <h3>Results:</h3> Of the 259 patients who formed the study population, 46% were women. The duration of follow-up ranged from 10 to 21 years. The average age at surgery was 25.80 ± 11.32 yrs; 49% had an aura, 61% had only hypomotor seizures and 38% had psychiatric comorbidity. The commonest pathology was hippocampal sclerosis(70%) followed by tumoral lesions and focal cortical dysplasia; 9.8% had acute post-operative seizures. At latest follow-up 75.6% were seizure free of which 52% had resolution of epilepsy. Presence of an aura , hippocampal sclerosis and longer time to first post-operative seizure were strong predictors for resolution of epilepsy while acute post-operative seizures and an abnormal post-surgery EEG at 1 year were predictors of persistent seizures. On survival analysis, the time to first seizure was significantly early in patients with persistent seizures. Seizure freedom both at three and five years predicted seizure freedom at 10 years. <h3>Conclusions:</h3> Resective surgery for drug resistant lesional TLE was associated with higher rate of seizure-freedom in ~75% and resolution of epilepsy in 52.15% even at long term follow-up. Longer time to first seizure, presence of aura at presentation and hippocampal sclerosis are strong predictors for resolution of epilepsy. APOS and abnormal Post-Surgery inter-ictal EEG are predictors of unfavourable outcome. <b>Disclosure:</b> Dr. Sattaluri has nothing to disclose. Dr. Patil has nothing to disclose. Dr. Choudhary has nothing to disclose. Dr. Vooturi has nothing to disclose.