The Role of Early Postoperative Seizures in Determining Long-term Success of Temporal Lobectomy

Introduction: Temporal lobectomy is a standard treatment for drug-resistant temporal lobe epilepsy. While early postoperative seizures (within 7 days) are known to affect long-term outcomes, the role of very early seizures (within 24 hours) remains unclear. This study aims to investigate the association between very early postoperative seizures and long-term seizure recurrence.

Methods: This retrospective cohort study included adult patients who underwent temporal lobectomy at the National Institute of Neurology and Neurosurgery between 2014 and 2023. Inclusion criteria were focal temporal lobe epilepsy and at least one year of postoperative follow-up. Medical records were reviewed for demographic data, preoperative seizure frequency, and postoperative outcomes, including early and very early postoperative seizures.

Results: Of 35 patients, 20 were females. The median age at first seizure was 10 years (IQR 5-17), at epilepsy diagnosis was 12 years (IQR 7-19), and at surgery was 40 years (IQR 29-45). Right-sided resections were performed in 24 patients. Postoperative seizures occurred in five patients, 1 within 24 hours and 4 between 24 hours and 7 days after surgery. Pre-surgery, the median seizure frequency was 8 seizures per month (spm) (IQR 5-20), which significantly decreased to 1 spm (IQR 1-2) postoperatively. At one-year follow-up, 20 patients (57.1%) achieved seizure freedom. Long term seizure freedom was not associated with having seizures in the first postoperative week (OR=0.145, 95%CI=0.014-1.464, p=0.07). This includes no association with seizures in the first 24 hours (OR=0.933, 95%CI=0.815-1.069, p=0.241) or during postoperative days 2-7 (OR=0.211, 95%CI=0.02-2.26, p=0.167).

Conclusion : While our findings were limited by a small sample size, we identified that most patients undergoing temporal lobectomy achieve seizure freedom at 1 year of follow-up. While seizures occurring in the first postoperative week did not significantly predict long-term seizure outcomes, these findings set a precedent for future investigations on factors predicting long term seizure outcomes.