PURPOSE: To investigate the longitudinal seizure outcome and identify potential prognostic indicators following posterior cortex epilepsy (PCE) surgery. METHODS: We reviewed patients who underwent a parietal, occipital, or parietooccipital resections between 1994 and 2006, using survival analysis and multivariate regression with Cox proportional hazard modeling. A favorable outcome was defined as Engel Class I at last follow-up. RESULTS: Fifty-seven patients were identified with a mean follow-up of 3.3 years (range 1-12 years). The estimated chance of seizure freedom (SF) was 73.1% at 6 postoperative months, 68.5% at 1 year, 65.8% at between 2 and 5 years, and 54.8% at 6 years and beyond. Most recurrences (75%) occurred within the first 6 postoperative months. Parietal resections had a worse outcome than occipital or parietooccipital resections (52% SF vs. 89% and 93%, respectively, at 5 years). Independent predictors of recurrence included an epilepsy etiology other than tumor or dysplasia [risk ratio (RR) 2.29], limiting resection to a lesionectomy (RR 2.10), having ipsilateral temporal spiking on preoperative scalp electroencephalography (EEG) (RR 2.06), or any ipsilateral spiking on postoperative EEG (RR 2.70) (Log likelihood-ratio test p < 0.0001). Only 40-50% of patients with a poor outcome predictor were SF at 5 postoperative years as opposed to about 80% otherwise. In surgical failures, recurrent seizure frequency was related directly to baseline seizure frequency and to the presence of ipsilateral spiking on postoperative EEG. DISCUSSION: These data highlight favorable long-term outcomes following PCE surgery. Limited surgical resection and diffuse baseline epileptogenicity may be important predictors of seizure recurrence.
PURPOSE: To investigate the longitudinal seizure outcome and identify potential prognostic indicators following posterior cortex epilepsy (PCE) surgery. METHODS: We reviewed patients who underwent a parietal, occipital, or parietooccipital resections between 1994 and 2006, using survival analysis and multivariate regression with Cox proportional hazard modeling. A favorable outcome was defined as Engel Class I at last follow-up. RESULTS: Fifty-seven patients were identified with a mean follow-up of 3.3 years (range 1-12 years). The estimated chance of seizure freedom (SF) was 73.1% at 6 postoperative months, 68.5% at 1 year, 65.8% at between 2 and 5 years, and 54.8% at 6 years and beyond. Most recurrences (75%) occurred within the first 6 postoperative months. Parietal resections had a worse outcome than occipital or parietooccipital resections (52% SF vs. 89% and 93%, respectively, at 5 years). Independent predictors of recurrence included an epilepsy etiology other than tumor or dysplasia [risk ratio (RR) 2.29], limiting resection to a lesionectomy (RR 2.10), having ipsilateral temporal spiking on preoperative scalp electroencephalography (EEG) (RR 2.06), or any ipsilateral spiking on postoperative EEG (RR 2.70) (Log likelihood-ratio test p < 0.0001). Only 40-50% of patients with a poor outcome predictor were SF at 5 postoperative years as opposed to about 80% otherwise. In surgical failures, recurrent seizure frequency was related directly to baseline seizure frequency and to the presence of ipsilateral spiking on postoperative EEG. DISCUSSION: These data highlight favorable long-term outcomes following PCE surgery. Limited surgical resection and diffuse baseline epileptogenicity may be important predictors of seizure recurrence.
Authors: Claire Haegelen; Piero Perucca; Claude-Edouard Châtillon; Luciana Andrade-Valença; Rina Zelmann; Julia Jacobs; D Louis Collins; François Dubeau; André Olivier; Jean Gotman Journal: Epilepsia Date: 2013-01-07 Impact factor: 5.864
Authors: Stephen C Harward; William C Chen; John D Rolston; Michael M Haglund; Dario J Englot Journal: Neurosurgery Date: 2018-03-01 Impact factor: 4.654
Authors: Lara Jehi; Nathalie Jette; Churl-Su Kwon; Colin B Josephson; Jorge G Burneo; Fernando Cendes; Michael R Sperling; Sallie Baxendale; Robyn M Busch; Chahnez Charfi Triki; J Helen Cross; Dana Ekstein; Dario J Englot; Guoming Luan; Andre Palmini; Loreto Rios; Xiongfei Wang; Karl Roessler; Bertil Rydenhag; Georgia Ramantani; Stephan Schuele; Jo M Wilmshurst; Sarah Wilson; Samuel Wiebe Journal: Epilepsia Date: 2022-07-17 Impact factor: 6.740