Independent predictors and a prognostic model for surgical outcome in refractory frontal lobe epilepsy

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• 作者：Ana P. Pinheiro-Martins^a ; ^{anapaulamartins@usp.br} ; ^{anappmartins@gmail.com} ; Marino M. Bianchin^c ; Tonicarlo R. Velasco^a ; Vera C. Terra^a ; David Araú ; jo Jr.^a ; Lauro Wichert-Ana^a ; Joã ; o A. Assirati Jr.^a ; ^b ; Hé ; lio R. Machado^a ; ^b ; Carlos G. Carlotti Jr.^a ; ^b ; Amé ; rico C. Sakamoto^a
• 关键词：Epilepsy surgery ; Frontal lobe epilepsy ; Surgical outcome
• 刊名：Epilepsy Research
• 出版年：2012
• 出版时间：March, 2012
• 年：2012
• 卷：99
• 期：1-2
• 页码：55-63
• 全文大小：1079 K

文摘

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Summary

Purpose

Refractory frontal lobe epilepsy (FLE) remains one of the most challenging surgically remediable epilepsy syndromes. Nevertheless, definition of independent predictors and predictive models of postsurgical seizure outcome remains poorly explored in FLE.

Methods

We retrospectively analyzed data from 70 consecutive patients with refractory FLE submitted to surgical treatment at our center from July 1994 to December 2006. Univariate results were submitted to logistic regression models and Cox proportional hazards regression to identify isolated risk factors for poor surgical results and to construct predictive models for surgical outcome in FLE.

Results

From 70 patients submitted to surgery, 45 patients (64 % ) had favorable outcome and 37 (47 % ) became seizure free. Isolated risk factors for poor surgical outcome are expressed in hazard ratio (H.R.) and were time of epilepsy (H.R. = 4.2; 95 % C.I. = 1.5-11.7; p = 0.006), ictal EEG recruiting rhythm (H.R. = 2.9; 95 % C.I. = 1.1-7.7; p = 0.033); normal MRI (H.R. = 4.8; 95 % C.I. = 1.4-16.6; p = 0.012), and MRI with lesion involving eloquent cortex (H.R. = 3.8; 95 % C.I. = 1.2-12.0; p = 0.021). Based on these variables and using a logistic regression model we constructed a model that correctly predicted long-term surgical outcome in up to 80 % of patients.

Conclusion

Among independent risk factors for postsurgical seizure outcome, epilepsy duration is a potentially modifiable factor that could impact surgical outcome in FLE. Early diagnosis, presence of an MRI lesion not involving eloquent cortex, and ictal EEG without recruited rhythm independently predicted favorable outcome in this series.