• Marta Hemb, Andre Palmini, Eliseu Paglioli, Eduardo Beck Paglioli, Jaderson Costa da Costa, Ney Azambuja, Mirna Portuguez, Verena Viuniski, Linda Booij, and Magda Lahorgue Nunes.
• Serviço de Neurologia, Hospital São Lucas da PUCRS. Av. Ipiranga, 6690 #220 90610-000, Porto Alegre, RS, Brazil; apalmini@uol.com.br.
• J. Neurol. Neurosurg. Psychiatr.. 2013 Jul 1;84(7):800-5.

ObjectivesTo evaluate the very long-term clinical outcome of surgery for mesial temporal lobe epilepsy and unilateral hippocampal sclerosis (MTLE/HS) without atypical features. The impact of surgical technique and postoperative reduction of medication on this outcome was investigated.DesignProspective longitudinal cohort follow-up study for up to18 years.SettingEpilepsy surgery centre in a university hospital.Patients108 patients who underwent unilateral MTLE/HS.InterventionSurgery for MTLE/HS.Main Outcome MeasureEngel classification (I). Clinical evaluations were based on systematic interviews in person or by phone. Kaplan-Maier survival curves estimated the probability of remaining seizure free. The impact of medication management in the postoperative outcome was analysed using Cox regression.ResultsThe probability of remaining completely seizure-free at 12 and 18 years after MTLE/HS surgery was 65% and 62%, respectively. The risk of having any recurrence was 22% during the first 24 months and increased 1.4% per year afterwards. Type of surgical technique (selective amygdalohippocampectomy vs anterior temporal lobectomy) did not impact on outcome. Remaining on antiepileptic drugs and history of generalised clonic seizure diminished the probability of remaining seizure free.ConclusionsMTLE/HS surgery is able to keep patients seizure free for almost up to two decades. Removal of the neocortex besides the mesial portion of the temporal lobe does not lead to better chances of seizure control. These findings are applicable to the typical unilateral MTLE/HS syndrome and cannot be generalised for all types of TLE. Future longitudinal randomised controlled studies are needed to replicate these findings.

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