Six Years of Surgical Treatment of Patients with Focal Pharmacoresistant Epilepsy: Single-Center Experience

Introduction Twenty to forty percent of patients with epilepsy continue to have disabling seizures after surgical treatment of temporal lobe epilepsy (TLE), and the percentage is higher in extratemporal cases. In our series, TLE is the most common type of epilepsy requiring surgical treatment in almost 90% of patients, while remaining 10% are patients with extratemporal epilepsy.

Aim Aim of this study is to present seizure outcome and complication rates in 102 surgically treated patients in the Clinical Center of Serbia in the past six years.

Materials and Methods A total of 102 patients prospectively analyzed in this study were operated in the period from January 2010 until June 2015. All patients underwent a complete presurgical evaluation in the Clinic of Neurology, and were operated in Clinic of Neurosurgery, Clinical Center of Serbia. The primary outcome variable was patient seizure status after surgery using ILAE outcome classification scale. Outcome was first assessed at 6 weeks and then at regular 6-month postoperative intervals. We also analyzed complication rates and prognostic factors influencing outcome.

Results The seizure-free rate at 1 year was 89% and decreased to 81% at 5.5 years after surgery (ILAE 1). Transitory complications are registered in nine patients, while one patient hade permanent complication (severe amnestic syndrome). We record five surgical (infection, ischemic lesion, hematoma) and seven neurological complication (dysphasia and memory dysfunction).

Conclusion Epilepsy surgery is an essential modality of treatment for patients with focal pharmacoresistant epilepsy with low morbidity and mortality rates. Our knowledge about the predictors of postoperative seizure freedom is essential since multiple prognostic factors seem to influence outcome after surgical resection.

Keywords epilepsy surgery; seizure outcome; prognostic factors