Jul 2026· Clinical neurology and neurosurgery (Dutch-Flemish ed. Print)· Vol 270, pp.
109599
· 0 citations· 23 references
Medicine
TL;DR
The findings did not yield any statistically significant results in this regard, and it is crucial that patients undergo surgical evaluation without delay to achieve seizure control and improve cognitive function.
Abstract
Objective
Resective surgery is a significant therapeutic option for patients with drug-resistant mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS). Numerous studies have demonstrated the efficacy of epilepsy surgery in the short to median term. However, studies on long-term outcomes are limited in number. The objective of this study was to document the long-term prognosis and associated factors of patients undergoing resective surgery for MTLE.
Methods
A retrospective analysis was conducted on the data of patients with drug-resistant MTLE due to HS who underwent resective surgery between 2001 and 2013 at our epilepsy centre. The demographics and clinical variables of the patients were documented and analysed in order to ascertain their long-term prognosis. The postoperative outcomes were evaluated in accordance with the Engel classification system.
Results
Of the 45 patients (mean age: 44.64 ± 8.96, range: 31-67), 31 (68.89%) were male. The age at onset of epilepsy, age at surgery, and the duration of epilepsy at the time of surgery ranged from 0.25 to 26 years (11.51 ± 7.07), from 12 to 47 years (26.82 ± 8.14), and from 2 to 33 years (16.03 ± 7.85), respectively. The patients were followed up for 10-23 years (17.73 ± 2.96). HS was identified in 23 (51.11%) of the patients on the right side and 22 (48.89%) on the left. The pre-operative EEG recordings revealed temporal discharges in 40 (88.89%) patients unilaterally. 22 patients (48.89%) underwent amygdalohippocampectomy with a temporal lobectomy (AH+ATL), while 23 patients (51.11%) underwent selective amygdalohippocampectomy (SAH). 28 (62.22%) patients were classified as Engel I. The patients did not have any statistically significant difference in terms of gender, age at epilepsy onset, age at surgery, duration of epilepsy at surgery, side of HS, and surgical procedure according to Engel classification (p = 0.64, 0.08, 0.60, 0.25, 0.67, 0.10, respectively). Executive and memory functions were improved after surgery at 5th year.
Conclusion
62% of the patients were classified as Engel I. Although previous studies have suggested that certain factors may influence prognosis, our findings did not yield any statistically significant results in this regard. It is crucial that patients undergo surgical evaluation without delay to achieve seizure control and improve cognitive function.
High-frequency IEDs on early postoperative EEG may identify patients at increased risk of long-term deterioration after surgery for HS-related TLE, and prospective studies are needed before modifying routine follow-up strategies.
Kate Durbano, Q. Calonge, Valerio Frazzini et al.· Seizure· 0 citations
To evaluate clinical predictors of adaptive functioning in pediatric patients with drug-resistant epilepsy (DRE) and the impact of corpus callosotomy and vagus nerve stimulation (VNS) using the Vineland Adaptive Behavior Scales (VABS) during long-term follow-up. This retrospective observational cohort study included 37 pediatric patients with DRE who underwent callosotomy (n = 24) or VNS (n = 13) at the Ribeirão Preto Epilepsy Surgery Program, University of São Paulo, between 2007 and 2018. Adaptive functioning was assessed using the VABS at three time points: preoperative, postoperative I (mean 25 months), and postoperative II (mean 51 months). Seizure outcomes were classified according to the Engel scale. Statistical analyses included analysis of variance, Pearson correlation, linear regression, and a general linear model for repeated measures. All patients presented adaptive delay preoperatively, with discrepancies between chronological age and age-equivalent scores. Postoperatively, seizure reduction occurred in 70.2% of patients, with most achieving Engel class II–III outcomes. A reduction in antiseizure medication use was observed in 43.2% of patients. Adaptive functioning declined at the first postoperative assessment but gradually improved over time, particularly among patients with better seizure control. Statistical analyses demonstrated significant effects of postoperative time and seizure outcomes on adaptive functioning, with greater improvements in patients with favorable seizure control (F = 4.183; p = 0.024). Palliative surgical procedures for pediatric DRE are safe and associated with seizure reduction, decreased medication burden, and gradual improvement in adaptive functioning. Early surgical intervention may help minimize developmental decline and improve long-term adaptive outcomes.
Ana Valeria Duarte Oliveira, H. Machado, Ú. Thomé et al.· Child's Nervous System· 0 citations
The model achieved high specificity in predicting long-term seizure recurrence, which supports its potential clinical utility for postoperative risk stratification and counseling rather than surgical exclusion and underscores the translational potential of network-level biomarkers to complement conventional predictors.
V.Yu. Karpychev, Rebecca W. Roth, William Yun et al.· Neurology· 0 citations
OBJECTIVE
Tuberous sclerosis complex (TSC) is a genetic multisystem disorder with a high prevalence of drug-resistant epilepsy (DRE), significantly affecting patients' quality of life. For patients with TSC lacking localizing epileptogenic tuber, resective surgery is often not feasible. Vagus nerve stimulation (VNS) has been proposed as an alternative surgical therapy, although robust evidence in TSC-related DRE remains limited.
METHODS
A prospective cohort study was conducted between December 2019 and July 2024 across multiple epilepsy centers in China. Seventy patients with TSC-related DRE were enrolled, all lacking resectable epileptogenic tubers on multidisciplinary evaluation and ineligible for resective surgery. Participants were divided into VNS (n = 20) and medication-only (n = 50) groups based on actual treatment, and followed for up to 3 years. Seizure outcomes, anti-seizure medication use, IQ, and quality of life were evaluated longitudinally.
RESULTS
The VNS group demonstrated significantly higher response rates at 1-, 2-, and 3-year follow-ups (65%-75%) compared to the medical treatment group (31%-36%). Median and average seizure frequency reductions were also greater in the VNS group. VNS was associated with significantly higher treatment response than medication, with the relative risk (RR) of response being 1.81 (95% confidence interval [CI]: 1.22-2.67), 2.21 (95% CI: 1.42-3.44), and 2.42 (95% CI: 1.49-3.93) at 1-, 2-, and 3-year follow-ups (p < 0.01). Seizure recurrence was significantly lower in the VNS group (p < 0.01). Moreover, VNS treatment led to significant reductions in anti-seizure medication (ASM) use and improvement in intelligence quotient and quality of life at the 2-year follow-up. Treatment modality was the only independent predictor of clinical response. VNS was well tolerated, with only mild surgical complications and no permanent adverse events reported.
SIGNIFICANCE
VNS significantly improves seizure control, cognitive outcomes, and quality of life, with a favorable safety profile. These findings support VNS as an effective and safe alternative for this specific TSC population. Future randomized controlled trials are warranted to further validate these results.
OBJECTIVE
To determine whether postoperative reduction of anti-seizure medication (ASM) burden is associated with cognitive improvement after anterior temporal lobectomy (ATL) in seizure-free patients.
METHODS
We retrospectively analyzed data for adult patients with drug-resistant temporal lobe epilepsy who underwent unilateral ATL between March 2013 and January 2025. Analyses were restricted to patients achieving complete freedom from seizures (Engel Class I) at 1 year. ASM burden was quantified using the prescribed daily dose/defined daily dose ratio, and the reduction rate was calculated. Preoperative and 1-year postoperative neuropsychological outcomes, including full-scale intelligence quotient (FSIQ) and domain-specific indices, were assessed. The effect of ASM reduction on cognitive change was evaluated using a doubly robust estimation framework integrating inverse probability of treatment weighting with multivariable outcome regression. Robustness and potential dose-response relationships were assessed via sensitivity analyses, analysis of covariance (ANCOVA), and categorical modeling.
RESULTS
Fifty-seven seizure-free patients were included in the primary analysis (median age at surgery, 32 years; 33 female). Greater ASM reduction was significantly associated with improved working memory (WM) (β = .066, p = .001). A positive but non-significant trend was observed for FSIQ (β = .021, p = .062). A dose-response relationship was identified, with greater ASM reduction associated with progressively greater improvement in WM (p = .013). Findings were consistent across sensitivity and ANCOVA analyses.
SIGNIFICANCE
Postoperative ASM reduction was associated with domain-specific cognitive improvement following ATL, particularly in WM. These findings support ASM tapering as a potentially modifiable factor influencing postoperative cognitive outcomes.
Kazushi Ukishiro, S. Osawa, M. Ogawa et al.· Epilepsia· 0 citations