Seizure · 2026
Preoperative systemic immune-inflammation index predicts seizure outcomes after anterior temporal lobectomy in drug-resistant temporal lobe epilepsy.
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Liu Renfu, Li Chengjun, Mei Zhen, Yu Weijie, Yang Zehan, Zeng Lingbo, Wang Shikai, Wang Feng, Lin Yuanxiang, Tian Yu
Аннотация
BACKGROUND: Anterior temporal lobectomy remains the most effective treatment for drug-resistant temporal lobe epilepsy, yet 20-40 % of patients experience persistent seizures postoperatively. Neuroinflammation plays a critical role in epileptogenesis, but the prognostic value of preoperative peripheral inflammatory markers has not been systematically evaluated. The systemic immune-inflammation index (SII), a composite marker integrating neutrophil, lymphocyte, and platelet counts, has demonstrated prognostic utility in cardiovascular disease and stroke but remains unexplored in surgical epilepsy.
OBJECTIVE: To investigate whether preoperative SII predicts seizure outcomes following anterior temporal lobectomy and to compare its prognostic performance against other inflammatory indices.
METHODS: This retrospective cohort study included 142 consecutive adult patients who underwent anterior temporal lobectomy for drug-resistant temporal lobe epilepsy between January 2018 and December 2024. Preoperative SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were calculated from routine complete blood counts obtained 3-7 days before surgery. The primary outcome was seizure freedom (Engel class I) at final follow-up. Receiver operating characteristic curve analysis evaluated discriminative performance, and multivariable logistic regression identified independent predictors of unfavorable outcome. Kaplan-Meier survival analysis assessed seizure-free survival stratified by SII group.
RESULTS: At median follow-up of 19 months, 92 patients (64.8 %) achieved seizure freedom. Patients with unfavorable outcomes had higher preoperative SII (median 768.40 vs. 483.02, p < 0.001). The SII demonstrated an area under the curve (AUC) of 0.763 (95 % CI: 0.682-0.843) for predicting unfavorable outcome, with optimal cutoff value of 676.65 yielding sensitivity of 62.0 % and specificity of 87.0 %. Using this threshold, seizure freedom was achieved in 80.0 % of low-SII patients compared to 28.6 % of high-SII patients (p < 0.001). The AUCs for the NLR and PLR were 0.749 and 0.703, respectively. DeLong tests showed no significant differences among these three indices (SII vs. NLR: p = 0.61; SII vs. PLR: p = 0.07; NLR vs. PLR: p = 0.33). In multivariable analysis adjusting for epilepsy duration, seizure frequency, hippocampal sclerosis, and surgical completeness, high SII remained an independent predictor of unfavorable outcome (OR 9.76, 95 % CI: 3.18-29.99, p < 0.001). Two-year seizure-free survival was 79.2 % in the low-SII group versus 28.1 % in the high-SII group (log-rank p < 0.001). The prognostic value of SII was consistent across subgroups defined by pathological substrate, age, and extent of resection.
CONCLUSIONS: Preoperative systemic immune-inflammation index independently predicts seizure outcomes following temporal lobectomy, with patients exhibiting elevated inflammatory burden experiencing substantially lower seizure-free rates. Although its predictive performance was not statistically superior to other inflammatory indices, SII offers potential utility as an adjunct for preoperative risk stratification and may inform personalized surgical management strategies. These findings support the broader concept that peripheral inflammatory status reflects epilepsy disease biology relevant to surgical outcomes.
OBJECTIVE: To investigate whether preoperative SII predicts seizure outcomes following anterior temporal lobectomy and to compare its prognostic performance against other inflammatory indices.
METHODS: This retrospective cohort study included 142 consecutive adult patients who underwent anterior temporal lobectomy for drug-resistant temporal lobe epilepsy between January 2018 and December 2024. Preoperative SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were calculated from routine complete blood counts obtained 3-7 days before surgery. The primary outcome was seizure freedom (Engel class I) at final follow-up. Receiver operating characteristic curve analysis evaluated discriminative performance, and multivariable logistic regression identified independent predictors of unfavorable outcome. Kaplan-Meier survival analysis assessed seizure-free survival stratified by SII group.
RESULTS: At median follow-up of 19 months, 92 patients (64.8 %) achieved seizure freedom. Patients with unfavorable outcomes had higher preoperative SII (median 768.40 vs. 483.02, p < 0.001). The SII demonstrated an area under the curve (AUC) of 0.763 (95 % CI: 0.682-0.843) for predicting unfavorable outcome, with optimal cutoff value of 676.65 yielding sensitivity of 62.0 % and specificity of 87.0 %. Using this threshold, seizure freedom was achieved in 80.0 % of low-SII patients compared to 28.6 % of high-SII patients (p < 0.001). The AUCs for the NLR and PLR were 0.749 and 0.703, respectively. DeLong tests showed no significant differences among these three indices (SII vs. NLR: p = 0.61; SII vs. PLR: p = 0.07; NLR vs. PLR: p = 0.33). In multivariable analysis adjusting for epilepsy duration, seizure frequency, hippocampal sclerosis, and surgical completeness, high SII remained an independent predictor of unfavorable outcome (OR 9.76, 95 % CI: 3.18-29.99, p < 0.001). Two-year seizure-free survival was 79.2 % in the low-SII group versus 28.1 % in the high-SII group (log-rank p < 0.001). The prognostic value of SII was consistent across subgroups defined by pathological substrate, age, and extent of resection.
CONCLUSIONS: Preoperative systemic immune-inflammation index independently predicts seizure outcomes following temporal lobectomy, with patients exhibiting elevated inflammatory burden experiencing substantially lower seizure-free rates. Although its predictive performance was not statistically superior to other inflammatory indices, SII offers potential utility as an adjunct for preoperative risk stratification and may inform personalized surgical management strategies. These findings support the broader concept that peripheral inflammatory status reflects epilepsy disease biology relevant to surgical outcomes.