NEUROLOGY 2005;65:912-918
© 2005 American Academy of Neurology
Predicting long-term seizure outcome after resective epilepsy surgery
The Multicenter Study
S. S. Spencer, MD,
A. T. Berg, PhD,
B. G. Vickrey, MD, MPH,
M. R. Sperling, MD,
C. W. Bazil, MD, PhD,
S. Shinnar, MD, PhD,
J. T. Langfitt, PhD,
T. S. Walczak, MD,
S. V. Pacia, MD for The Multicenter Study of Epilepsy Surgery
From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; and Department of Neurology (Dr. Pacia), New York University School of Medicine, New York, NY.
Address correspondence and reprint requests to Dr. Susan S. Spencer, Yale School of Medicine, P.O. Box 208018, New Haven, CT 06520-8018; e-mail: susan.spencer{at}yale.edu
Background: In a seven-center prospective observational study of resective epilepsy surgery, the authors examined probability and predictors of entering 2-year remission and the risk of subsequent relapse.
Methods: Patients aged 12 years and over were enrolled at time of referral for epilepsy surgery, and underwent standardized evaluation, treatment, and follow-up procedures. The authors defined seizure remission as 2 years completely seizure-free after hospital discharge with or without auras, and relapse as any seizures after 2-year remission. The authors examined type of surgery, seizure, clinical and demographic variables, and localization study results with respect to prediction of seizure remission or relapse, using  2 and proportional hazards analysis.
Results: Of 396 operated patients, 339 were followed over 2 years, and 223 (66%) experienced 2-year remission, not significantly different between medial temporal (68%) and neocortical (50%) resections. In multivariable models, only absence of generalized tonic-clonic seizures and presence of hippocampal atrophy were significantly and independently associated with remission, and only in the medial temporal resection group. Fifty-five patients relapsed after 2-year remission, again not significantly different between medial temporal (25%) and neocortical (19%) resections. Only delay to remission predicted relapse, and only in medial temporal patients.
Conclusion: Hippocampal atrophy and a history of absence of generalized tonic clonic seizures were the sole predictors of 2-year remission, and only for medial temporal resections.
Supported by NIH-R01NS32375.
Disclosure: The authors report no conflicts of interest.
Received March 1, 2005. Accepted in final form June 10, 2005.
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