Long-term prognostic value of early post-operative electroencephalogram in patients with drug-resistant temporal lobe epilepsy associated with hippocampal sclerosis.
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.
Abstract
Purpose
Surgery is the treatment of choice for drug-resistant temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS). We assessed whether interictal epileptiform discharges (IEDs) on early postoperative EEG predicted seizure outcome after surgery.
Methods
We retrospectively included consecutive patients aged >16 years who underwent surgery for drug-resistant TLE with pathologically confirmed HS at Pitié-Salpêtrière Hospital, Paris, between 2003 and 2023. Eligible patients had at least 1 year of follow-up and an early postoperative EEG performed within 1 month after surgery. IED frequency was classified as high frequency (≥1/min) or low frequency (<1/min). Favourable 1-year outcome was defined as ILAE class 1. Long-term worsening was defined as any increase in ILAE class after the 1-year visit.
Results
Among 168 patients, 131 (78.0%) were ILAE class 1 at 1 year. EEG was performed a median of 7 days after surgery. IEDs were present in 81 patients (48.2%), including 48 with low-frequency and 33 with high-frequency IEDs. EEG features, including IED presence and frequency, did not differ between patients with and without ILAE class 1 outcome at 1 year. During longer follow-up, high-frequency IEDs were associated with worsening compared with no IEDs in the whole cohort (HR 2.25, 95% CI 1.01-4.98; p=0.046) and among patients seizure-free at 1 year (HR 2.59, 95% CI 1.10-6.11; p=0.03). Low-frequency IEDs were not associated with worsening.
Conclusion
High-frequency IEDs on early postoperative EEG may identify patients at increased risk of long-term deterioration after surgery for HS-related TLE. Prospective studies are needed before modifying routine follow-up strategies.
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.
Günay Gül, Fulya Eren, Melek Kandemir Yilmaz et al.· Clinical neurology and neuro...· 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
The findings suggest that referring children for surgery sooner rather than later can meaningfully improve their chances of living seizure‐free and underscore the importance of achieving complete lesion removal to optimize postoperative seizure control.
Hua Li, Yao Wang, Qiang Guo et al.· Epilepsia Open· 0 citations
OBJECTIVE
To describe 5-year mortality after status epilepticus (SE) and identify factors associated with long-term survival. We also validated the prognostic performance of the Age, Consciousness, Duration (ACD) score and evaluated long-term survival across etiological categories defined by the Lattanzi classification of acute symptomatic SE.
METHODS
Retrospective cohort analysis of a prospectively maintained database of consecutive patients ≥16 years of age with confirmed SE admitted to a tertiary epilepsy center (2011-2022). We excluded unclear diagnoses, hypoxic-anoxic etiologies, and incomplete follow-up. We recorded clinical variables and prognostic scores modified Status Epilepticus Severity Score (mSTESS), Epidemiology-based Mortality Status Epilepticus (EMSE), and Age, Consciousness, Duration (ACD). Mortality was assessed at discharge and annually up to 5 years.
RESULTS
We included 786 patients (mean age 63.4 years, 43.5% female). Five-year mortality was 50.3%, with 44.0% of deaths occurring within the first 2 years. Neurological causes accounted for 60.8% of deaths, and direct seizure-related causes represented 74.6% of neurological deaths. Independent predictors of higher long-term mortality were older age, higher premorbid mRS, absence of prior seizure history, comorbidity burden, systemic complications, and impaired consciousness during SE; convulsive and focal motor SE were associated with lower mortality risk. mSTESS and EMSE were associated with long-term mortality. In patients with less damaging etiologies, ACD predicted 5-year mortality (hazard ratio [HR] 1.163, 95% confidence interval [CI] 1.063-1.273; area under the curve [AUC] 0.717); ACD ≥10 corresponded to >50% 2-year mortality. Five-year mortality was 61.3% (acute-primary Central Nervous System (CNS) and 58.3% (acute-secondary CNS).
SIGNIFICANCE
SE carries substantial long-term mortality, particularly within the first 2 years. Neurological and seizure-related causes were the most frequent. The Lattanzi classification and the ACD score retained long-term prognostic value.
Manuel Alanís-Bernal, D. Campos-Fernández, L. Abraira et al.· Epilepsia· 0 citations
Palliative surgical procedures for pediatric DRE are safe and associated with seizure reduction, decreased medication burden, and gradual improvement in adaptive functioning and 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
Postoperative ASM reduction was associated with domain-specific cognitive improvement following ATL, particularly in WM, which support ASM tapering as a potentially modifiable factor influencing postoperative cognitive outcomes.
Kazushi Ukishiro, S. Osawa, M. Ogawa et al.· Epilepsia· 0 citations