Predictors and outcome surgery for posterior cortex epilepsies

Abstract

Objective: The aim of this study is to identify the prognostic role of MRI and EEG in posterior cortex epilepsies (PCES) and to characterize their clinical features.

Patient and methods: We retrospectively studied 54 consecutive patients (18 females, 36 males) from April 2011 to November 2015, who had undergone PCES surgery. Electro-clinical, pathological and surgical data were evaluated. Of the patients, 18 (33.3%) patients underwent a cortical resection (corticectomy), 10 (18.5%) lobectomy, 6 (11.1%) multilobar resection, 20 (30.1%) disconnection.

Results: The postoperative follow-up duration was ≥1 year in all patients (12-44 months, mean = 25). Thirty-two patients (59.3%) became seizure free (ILAE 1) and 40 (74.1%) had a good (ILAE 1, 2, 3) outcome. The most common pathological finding was focal cortical dysplasia (in 34 patients). Univariate analysis showed that regional scalp interictal epilepsy discharges (IEDs) (P = 0.031), Regional EEG onset (P = 0.027), a MRI lesion (P = 0.001) and the number of seizures that were recorded by the epilepsy monitor unit (P = 0.016) were significantly associated with freedom from seizures. Multivariate analysis confirmed that MRI positive was statistically significant (HR = 4.284, CI = 1.198-15.315).

Conclusions: Surgical treatment is effective for PCES, and MRI and EEG analyses are important in presurgical evaluation of PCES.

Keywords: Epilepsy surgery; Outcome; Posterior cortex epilepsies.