BACKGROUND: Surgery is increasingly used as treatment for refractory focal epilepsy; however, few rigorous reports of long-term outcome exist. We did this study to identify long-term outcome of epilepsy surgery in adults by establishing patterns of seizure remission and relapse after surgery. METHODS: We report long-term outcome of surgery for epilepsy in 615 adults (497 anterior temporal resections, 40 temporal lesionectomies, 40 extratemporal lesionectomies, 20 extratemporal resections, 11 hemispherectomies, and seven palliative procedures [corpus callosotomy, subpial transection]), with prospective annual follow-up for a median of 8 years (range 1-19). We used Kaplan-Meier survival analysis to estimate time to first seizure, and investigated patterns of seizure outcome. FINDINGS: We used survival methods to estimate that 52% (95% CI 48-56) of patients remained seizure free (apart from simple partial seizures [SPS]) at 5 years after surgery, and 47% (42-51) at 10 years. Patients who had extratemporal resections were more likely to have seizure recurrence than were those who had anterior temporal resections (hazard ratio [HR] 2·0, 1·1-3·6; p=0·02); whereas for those having lesionectomies, no difference from anterior lobe resection was recorded. Those with SPS in the first 2 years after temporal lobe surgery had a greater chance of subsequent seizures with impaired awareness than did those with no SPS (2·4, 1·5-3·9). Relapse was less likely the longer a person was seizure free and, conversely, remission was less likely the longer seizures continued. In 18 (19%) of 93 people, late remission was associated with introduction of a previously untried antiepileptic drug. 104 of 365 (28%) seizure-free individuals had discontinued drugs at latest follow-up. INTERPRETATION: Neurosurgical treatment is appealing for selected people with refractory focal epilepsy. Our data provide realistic expectations and indicate the scope for further improvements in presurgical assessment and surgical treatment of people with chronic epilepsy. FUNDING: UK Department of Health National Institute for Health Research (NIHR) Biomedical Research Centres funding scheme, Epilepsy Society, Dr Marvin Weil Epilepsy Research Fund.
BACKGROUND: Surgery is increasingly used as treatment for refractory focal epilepsy; however, few rigorous reports of long-term outcome exist. We did this study to identify long-term outcome of epilepsy surgery in adults by establishing patterns of seizure remission and relapse after surgery. METHODS: We report long-term outcome of surgery for epilepsy in 615 adults (497 anterior temporal resections, 40 temporal lesionectomies, 40 extratemporal lesionectomies, 20 extratemporal resections, 11 hemispherectomies, and seven palliative procedures [corpus callosotomy, subpial transection]), with prospective annual follow-up for a median of 8 years (range 1-19). We used Kaplan-Meier survival analysis to estimate time to first seizure, and investigated patterns of seizure outcome. FINDINGS: We used survival methods to estimate that 52% (95% CI 48-56) of patients remained seizure free (apart from simple partial seizures [SPS]) at 5 years after surgery, and 47% (42-51) at 10 years. Patients who had extratemporal resections were more likely to have seizure recurrence than were those who had anterior temporal resections (hazard ratio [HR] 2·0, 1·1-3·6; p=0·02); whereas for those having lesionectomies, no difference from anterior lobe resection was recorded. Those with SPS in the first 2 years after temporal lobe surgery had a greater chance of subsequent seizures with impaired awareness than did those with no SPS (2·4, 1·5-3·9). Relapse was less likely the longer a person was seizure free and, conversely, remission was less likely the longer seizures continued. In 18 (19%) of 93 people, late remission was associated with introduction of a previously untried antiepileptic drug. 104 of 365 (28%) seizure-free individuals had discontinued drugs at latest follow-up. INTERPRETATION: Neurosurgical treatment is appealing for selected people with refractory focal epilepsy. Our data provide realistic expectations and indicate the scope for further improvements in presurgical assessment and surgical treatment of people with chronic epilepsy. FUNDING: UK Department of Health National Institute for Health Research (NIHR) Biomedical Research Centres funding scheme, Epilepsy Society, Dr Marvin Weil Epilepsy Research Fund.
Authors: Maged Goubran; Boris C Bernhardt; Diego Cantor-Rivera; Jonathan C Lau; Charlotte Blinston; Robert R Hammond; Sandrine de Ribaupierre; Jorge G Burneo; Seyed M Mirsattari; David A Steven; Andrew G Parrent; Andrea Bernasconi; Neda Bernasconi; Terry M Peters; Ali R Khan Journal: Hum Brain Mapp Date: 2015-12-17 Impact factor: 5.038
Authors: Giovanni Assenza; Mario Tombini; Jacopo Lanzone; Lorenzo Ricci; Vincenzo Di Lazzaro; Sara Casciato; Alessandra Morano; Anna Teresa Giallonardo; Carlo Di Bonaventura; Ettore Beghi; Edoardo Ferlazzo; Sara Gasparini; Loretta Giuliano; Francesco Pisani; Paolo Benna; Francesca Bisulli; Fabrizio A De Falco; Silvana Franceschetti; Angela La Neve; Stefano Meletti; Barbara Mostacci; Ferdinando Sartucci; Pasquale Striano; Flavio Villani; Umberto Aguglia; Giuliano Avanzini; Vincenzo Belcastro; Amedeo Bianchi; Vittoria Cianci; Angelo Labate; Adriana Magaudda; Roberto Michelucci; Annapia Verri; Gaetano Zaccara; Vincenzo Pizza; Paolo Tinuper; Giancarlo Di Gennaro Journal: Neurol Sci Date: 2020-06-10 Impact factor: 3.307
Authors: Siobhan West; Sarah J Nevitt; Jennifer Cotton; Sacha Gandhi; Jennifer Weston; Ajay Sudan; Roberto Ramirez; Richard Newton Journal: Cochrane Database Syst Rev Date: 2019-06-25
Authors: Su Liu; Candan Gurses; Zhiyi Sha; Michael M Quach; Altay Sencer; Nerses Bebek; Daniel J Curry; Sujit Prabhu; Sudhakar Tummala; Thomas R Henry; Nuri F Ince Journal: Brain Date: 2018-03-01 Impact factor: 13.501