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Focal to bilateral motor seizures in temporal lobe epilepsy during video-EEG monitoring: effects on surgical outcome

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Abstract

The aim of this study was to determine whether the occurrence of focal to bilateral motor seizures in the course of partial drug withdrawal during video-EEG monitoring (FTBMS-M) had a predictive value for seizure recurrence in surgically treated patients with mesial temporal lobe epilepsy (MTLE). We analyzed the outcomes of 59 patients who underwent temporal lobe resection at 12 month postoperative follow up. In total, 48 out of 59 patients were rendered seizure free (81.4%). We analyzed seizure recurrence after surgery with reference to: (i) occurrence of seizures after partial drug withdrawal during video-EEG monitoring (FTBMS-M); (ii) history of secondarily generalized seizures during antiepileptic drug treatment prior to presurgical evaluation (FTBMS-H) and (iii) other possible confounding factors (sex, age, epilepsy duration, side of surgery, presence of hippocampal sclerosis, and history of febrile seizures). We found no differences in the frequency of seizure recurrences between patients with FTBMS-M and patients without FTBMS-M (4/20 vs. 7/39; p = 0.848). Conversely, the frequency of seizure recurrence was significantly higher among the patients with FTBMS-H than among the patients without FTBMS-H (7/20 vs. 4/39; p = 0.021). The predictive value of FTBMS-H for postoperative seizure recurrence was confirmed in logistic regression analysis. We found a statistically significant influence of FTBMS-H on poor outcome after surgery, but not of FTBMS-M or other confounding variables, which suggests that withdrawal seizures do not affect postsurgical seizure control.

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Acknowledgements

Dedicated to the memory of Robert Kuba from the Brno Epilepsy Center. He will live on in our hearts forever. The authors wish to thank Ivan Soldatović and Ognjen Milićević for statistical analysis. Also, many thanks go Tto Anne Johnson for grammatical assistance and language editing.

Funding

The research was conducted at The Neurology Clinic, Clinical Center of Serbia in cooperation with The Neurology Department of Faculty of Medicine, University of Belgrade as a part of regular research activities. There was no external funding.

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Authors and Affiliations

  1. Neurology Clinic, Clinical Center of Serbia, Dr. Subotić Street 6, 11 000, Belgrade, Serbia

    Maša Kovačević, Dragoslav Sokić, Aleksandar J. Ristić, Tijana Đukić, Aleksa Pejović & Nikola Vojvodić

  2. Faculty of Medicine, University of Belgrade, Dr. Subotić Street 8, 11 000, Belgrade, Serbia

    Dragoslav Sokić, Aleksandar J. Ristić, Vladimir Baščarević & Nikola Vojvodić

  3. Clinic for Neurosurgery, Clinical Center of Serbia, Kosta Todorović Street 4, 11 000, Belgrade, Serbia

    Vladimir Baščarević

Authors
  1. Maša Kovačević
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  2. Dragoslav Sokić
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  3. Aleksandar J. Ristić
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  4. Vladimir Baščarević
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  5. Tijana Đukić
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  6. Aleksa Pejović
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  7. Nikola Vojvodić
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MK, NV and AR. The first draft of the manuscript was written by NV and all authors commented on previous versions of the manuscript. All subsequent manuscript editions were written by MK. All authors read and approved the final manuscript.

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Correspondence to Maša Kovačević.

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Conflicts of interest

The authors have no conflicts of interests or competing interests to declare.

Ethics approval

The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Since the research was performed retrospectively, the authors were not required to obtain formal ethics approval.

Consent to participate

Patients were offered a written consent form for participation in this as well as further research. Subjects were informed that declining to participate in research and publication would not influence the course of their treatment. All the subjects included were compliant with their information being used for research purposes, which was verified with their hand signature or hand signature of their legal guardian when applicable.

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The study subjects provided informed consent for publication of their data in the previously mentioned written consent form.

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Kovačević, M., Sokić, D., Ristić, A.J. et al. Focal to bilateral motor seizures in temporal lobe epilepsy during video-EEG monitoring: effects on surgical outcome. Acta Neurol Belg 121, 1677–1684 (2021). https://doi.org/10.1007/s13760-020-01471-7

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  • DOI: https://doi.org/10.1007/s13760-020-01471-7

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