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. 2023 May;270(5):2715-2723.
doi: 10.1007/s00415-023-11603-7. Epub 2023 Feb 10.

Early identification of seizure freedom with medical treatment in patients with mesial temporal lobe epilepsy and hippocampal sclerosis

Margaux Cheval  1   2   3 , Marion Houot  4   5   6 , Nathalie Chastan  7 , William Szurhaj  8 , Cécile Marchal  9 , Hélène Catenoix  10   11 , Luc Valton  12   13 , Martine Gavaret  14 , Bastien Herlin  15   16   17 , Arnaud Biraben  18 , Stanislas Lagarde  19   20 , Laure Mazzola  21 , Lorella Minotti  22   23 , Louis Maillard  24   25 , Sophie Dupont  26   27   28   29
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Free article

Early identification of seizure freedom with medical treatment in patients with mesial temporal lobe epilepsy and hippocampal sclerosis

Margaux Cheval et al. J Neurol. 2023 May.
Free article

Abstract

Background: Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is usually associated with a poor response to antiseizure medications. We focused on MTLE-HS patients who were seizure free on medication to: (1) determine the clinical factors associated with seizure freedom and (2) develop a machine-learning classifier to better earlier identify those patients.

Methods: We performed a retrospective, multicentric study comparing 64 medically treated seizure-free MTLE-HS patients with 200 surgically treated drug-resistant MTLE-HS patients. First, we collected medical history and seizure semiology data. Then, we developed a machine-learning classifier based on clinical data.

Results: Medically treated seizure-free MTLE-HS patients were seizure-free for at least 2 years, and for a median time of 7 years at last follow-up. Compared to drug-resistant MTLE-HS patients, they exhibited: an older age at epilepsy onset (22.5 vs 8.0 years, p < 0.001), a lesser rate of: febrile seizures (39.0% vs 57.5%, p = 0.035), focal aware seizures (previously referred to as aura)(56.7% vs 90.0%, p < 0.001), autonomic focal aware seizures in presence of focal aware seizure (17.6% vs 59.4%, p < 0.001), dystonic posturing of the limbs (9.8% vs 47.0%, p < 0.001), gestural (27.4% vs 94.0%, p < 0.001), oro-alimentary (32.3% vs 75.5%, p < 0.001) or verbal automatisms (12.9% vs 36.0%, p = 0.001). The classifier had a positive predictive value of 0.889, a sensitivity of 0.727, a specificity of 0.962, a negative predictive value of 0.893.

Conclusions: Medically treated seizure-free MTLE-HS patients exhibit a distinct clinical profile. A classifier built with readily available clinical data can identify them accurately with excellent positive predictive value. This may help to individualize the management of MTLE-HS patients according to their expected pharmacosensitivity.

Keywords: Hippocampal sclerosis; Machine-learning; Medically treated; Mesial temporal lobe epilepsy; Predictive factors; Seizure freedom.

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