Early seizures after temporal lobectomy predict future seizures

Although traditionally considered benign, early seizures after temporal lobectomy predict subsequent seizure recurrence, according to an Australian study.Although early seizures after temporal lobectomy have been considered benign and associated with perioperative factors, an Australian has found that they predict the risk of future seizures. The study examined the association between postoperative seizures occurring within 4 weeks of anterior temporal lobectomy and seizure recurrence in the first postoperative year. The study also examined whether patients who experienced early seizures had a poorer long-term (3-year) outcome than those who experienced seizures later in the first year.Of 321 patients included in the analysis, 69 (22%) experienced early postoperative seizures. Compared to patients who remained seizure-free in the four weeks after surgery, patients with early postoperative seizures and no associated "precipitants" (low levels of antiepileptic drugs (AEDs), cessation of AEDs, etc.) had an almost eight-fold increased risk of experiencing seizures during the year after surgery. Patients who experienced early seizures and were identified as having seizure precipitants had a three-fold increased risk of recurrent seizures. Long-term outcome did not differ according to whether seizures occurred in the first 28 postoperative days or during the first postoperative year. However, the group of patients experiencing a seizure at any time during the first year had a poorer outcome by the third year compared with patients who were seizure-free in the first year.The authors say that it is possible that early seizures are, "a manifestation of a residual fixed epileptogenic region, or a more diffuse 'intractability factor' independent of preoperative pathology type." The lower risk of recurrent seizures in the group with seizure precipitants may be because "...this group comprised those who experienced true benign reactive seizures together with other patients who had ongoing intractable epilepsy," they suggest. The authors conclude that all early seizures should be considered potentially relevant to the long-term outcome of the patient. They say their results, "...strongly suggest that there is no time during the first four postoperative weeks when seizures can be considered benign." They add, "The practice of discounting early postoperative seizures may result in missed opportunities to provide early patient counselling and to identify the causes of refractory epilepsy after surgery."Reference...