Significance of post-operative auras after temporal lobectomy: A surprising methodological trap

We aimed to examine post-operative auras/simple partial seizures and the associated risk of seizure recurrence after temporal lobectomy. Included were 159 patients who underwent anterior temporal lobectomy (1995-2006) at Austin Health, Australia. Initial analyses used Cox regression. Post-hoc, exploratory analyses of aura and seizure patterns were undertaken. Initial analyses indicated that post-operative auras were not associated with subsequent disabling seizures (HR 0.65, 95%CI 0.4-1.1 p = 0.08). However, post-hoc examination found data patterns that suggest that post-operative auras may have been under-reported when medical contact between these events was absent. These findings are relevant to current research, as similar methodology is commonly employed in post-operative outcome studies. Important implications include potential underestimation of seizure risk associated with auras. Carefully planned prospective studies are required to assess the risk associated with post-operative auras.

► We examined seizure-recurrence risk associated with post-lobectomy auras. ► Patterns of outcome suggested under-report of auras. ► Implications include possible underestimation of risk. ► The issues identified are relevant to the methodology of future studies.