Long-term Outcomes in Surgical Patients with Intractable Temporal Lobe Epilepsy (5271)

Objective: To determine the long term outcomes of epilepsy surgery at a comprehensive epilepsy center. Background: Despite new anti-epileptic therapy options, more than 30% of patients with epilepsy will become medically intractable. There have been many studies demonstrating the efficacy of temporal lobe surgery in short term follow up, but fewer studies with long term seizure freedom data. Design/Methods: Upon IRB approval we performed a retrospective review of 162 patients that had temporal lobe surgery at Rush University Medical Center between 1/18/96–2/5/09. Patients’ surgical outcome using the Engel classification was documented at 5, 10, 15, and 20 years in addition to the most recent follow up appointment. Results: 162 patients (91 female, 71 male) met inclusion criteria. 20 patients were lost to follow up and excluded from the analysis. Patients were followed for an average of 13.3 years (± 5.2 years). 110 patients were Engel class I, 78 of which were class 1A at their last follow up. Neither age of onset nor duration of epilepsy at surgery were associated with a particular outcome, likewise pre-operative seizure frequency did not predict seizure outcome post-operatively. At last follow up appointment, 86% of those who underwent a left temporal lobectomy versus 66% after a right temporal lobectomy, achieved seizure freedom, p = 0.002. Conclusions: This large cohort of patients with temporal lobe epilepsy demonstrates that the majority of patients achieve long term seizure freedom after temporal lobe resection. Further analysis is currently underway to determine predictive factors of outcome, as initial analysis yielded unexpected results. Left temporal lobectomy outcomes were better and could be due to a more thorough and certain work up given the dominant temporal lobe being resected. Seizure freedom remained relatively consistent, suggesting that early seizure freedom post-operatively will be maintained long-term. Disclosure: Dr. Torrison has nothing to disclose. Dr. Osen has nothing to disclose. Dr. Sani has nothing to disclose. Dr. Byrne has nothing to disclose. Dr. Ouyang has nothing to disclose. Dr. O’Dwyer has nothing to disclose.