Predictors of surgical outcome in frontal lobe epilepsy: Experience from a single-center cohort in Latin America.

BACKGROUND

Frontal lobe epilepsy (FLE) is the second most common type of focal epilepsy and among the most challenging to diagnose and treat. Although surgical resection offers potential seizure freedom, outcomes vary, and high-quality data from low- and middle-income countries are scarce. This study aimed to describe a cohort of patients with FLE undergoing epilepsy surgery and identify clinical, imaging, and pathological factors associated with favorable outcomes.

METHODS

A retrospective observational study was conducted on 40 consecutive patients with drug-resistant FLE who underwent resective epilepsy surgery at a tertiary center in Bogotá, Colombia, between 2016 and 2024. Data on clinical features, neuroimaging, surgery, and histopathology were collected. Surgical outcomes were classified using the Engel Epilepsy Surgery Outcome Scale; Engel class I or II was considered favorable. Bivariate analyses were performed to identify predictors of good outcomes.

RESULTS

Median age at surgery was 25.5 years (IQR: 14.8-34.8); 67.5 % were male and 92.5 % right-handed. Semiological group 1 (motor/premotor cortex) was most common (75 %). At median 29.7 months follow-up, 57.5 % achieved favorable outcomes. Astrogliosis was the only histopathological finding significantly associated with favorable outcomes among resective cases (p = 0.041). Trends toward better outcomes were seen in patients with standard resections (p = 0.053) and identifiable lesions, though not statistically significant.

CONCLUSIONS

Epilepsy surgery for FLE is feasible and safe in middle-income countries and can yield outcomes similar to global reports. These results underscore the importance of early referral, detailed semiological analysis, and lesion detection for surgical planning in drug-resistant FLE.