Long-term seizure outcomes of epilepsy surgery in patients with mesial temporal lobe epilepsy caused by hippocampal sclerosis based on preoperative ictal versus non-ictal video-EEG: A 10-year follow-up.

INTRODUCTION

Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is a frequent cause of drug-resistant epilepsy (DRE). In these cases, anterior temporal lobectomy (ATL) is an effective treatment in well-selected patients. While ictal video-electroencephalogram (video-EEG) remains the gold standard for localizing the epileptogenic zone, some studies have suggested that non-ictal video-EEG, when concordant with MRI, may be sufficient to perform ATL.

OBJECTIVE

To compare long-term outcomes in patients who underwent ATL with ictal video-EEG versus non-ictal video-EEG by presenting one of the first comprehensive 10-year follow-up analyses.

METHODS

An observational, ambispective, longitudinal, and analytic cohort was used to compare the long-term seizure outcomes in patients with MTLE-HS who underwent ATL with ictal video-EEG versus non-ictal video-EEG preoperative monitoring evaluation at a neurology and neurosurgery hospital.

RESULTS

A total of 122 patients with MTLE-HS who underwent ATL were included. Preoperative ictal video-EEG was available for 73 patients (59.8 %), and 49 patients (40.2 %) were evaluated using non-ictal video-EEG. MRI concordance was observed in 62 patients (84.9 %) of the ictal and 41 patients (83.7 %) of the non-ictal group. Overall, 78 patients (63.9 %) were seizure-free: 47 (64.4 %) in the ictal group and 31 (63.3 %) in the non-ictal group (p = 0.89). No significant difference in seizure freedom was observed between groups over a 10-year follow-up (log-rank p = 0.24).

CONCLUSION

In patients with MTLE-HS, ATL guided by non-ictal video-EEG with concordant clinical and MRI findings could achieve seizure freedom outcomes comparable to those obtained with ictal video-EEG. These results support the use of non-ictal evaluations in resource-limited settings.