PURPOSE: This study aims to investigate seizure worsening and its predictors after epilepsy surgery. METHODS: A retrospective chart review of patients who underwent unilobar epilepsy surgery between 1990 and 2007 and had recurrence of at least one seizure was performed. Seizure worsening was defined as an increase in total average monthly seizure frequency, average monthly generalized tonic-clonic seizures (GTCS), new-onset GTCS, or new-onset status epilepticus. The occurrence of sudden unexpected death in epilepsy (SUDEP) was captured. Multivariate logistic regression analysis was used to identify predictors of worsening. KEY FINDINGS: A total of 276 patients with postoperative seizure recurrence were identified. Monthly average seizure frequency worsening occurred in 9.8%, GTC worsening in 8.0%, new-onset GTCs in 1.4%, new-onset status epilepticus in 2.2%, and death from SUDEP in 1.4%. A higher risk of worsening was seen with extratemporal resections as compared to temporal lobe surgeries (odds ratio [OR] 3.11, 95% confidence interval [CI] 1.21-7.95; p = 0.018), and in patients with low preoperative seizure frequency <30 seizures/month (OR 14.82, 95% CI 2.81-275.41; p = 0.0003). Predictors of increased GTCs included an incomplete resection (OR 3.98, 95% CI 1.39-12.59; p = 0.010) and multiple recorded ictal patterns (OR 5.91, 95% CI 1.20-26.96; p = 0.030). Multiple seizure semiologies correlated with worsening after temporal lobe resections. SIGNIFICANCE: The most vulnerable patients for seizure worsening following epilepsy surgery include those with extratemporal resections, incomplete resections, and multiple recorded ictal patterns. Wiley Periodicals, Inc.
PURPOSE: This study aims to investigate seizure worsening and its predictors after epilepsy surgery. METHODS: A retrospective chart review of patients who underwent unilobar epilepsy surgery between 1990 and 2007 and had recurrence of at least one seizure was performed. Seizure worsening was defined as an increase in total average monthly seizure frequency, average monthly generalized tonic-clonic seizures (GTCS), new-onset GTCS, or new-onset status epilepticus. The occurrence of sudden unexpected death in epilepsy (SUDEP) was captured. Multivariate logistic regression analysis was used to identify predictors of worsening. KEY FINDINGS: A total of 276 patients with postoperative seizure recurrence were identified. Monthly average seizure frequency worsening occurred in 9.8%, GTC worsening in 8.0%, new-onset GTCs in 1.4%, new-onset status epilepticus in 2.2%, and death from SUDEP in 1.4%. A higher risk of worsening was seen with extratemporal resections as compared to temporal lobe surgeries (odds ratio [OR] 3.11, 95% confidence interval [CI] 1.21-7.95; p = 0.018), and in patients with low preoperative seizure frequency <30 seizures/month (OR 14.82, 95% CI 2.81-275.41; p = 0.0003). Predictors of increased GTCs included an incomplete resection (OR 3.98, 95% CI 1.39-12.59; p = 0.010) and multiple recorded ictal patterns (OR 5.91, 95% CI 1.20-26.96; p = 0.030). Multiple seizure semiologies correlated with worsening after temporal lobe resections. SIGNIFICANCE: The most vulnerable patients for seizure worsening following epilepsy surgery include those with extratemporal resections, incomplete resections, and multiple recorded ictal patterns. Wiley Periodicals, Inc.
Authors: Aria Fallah; Evan Lewis; George M Ibrahim; Olivia Kola; Chi-Hong Tseng; William B Harris; Jia-Shu Chen; Kao-Min Lin; Li-Xin Cai; Qing-Zhu Liu; Jiu-Luan Lin; Wen-Jing Zhou; Gary W Mathern; Matthew D Smyth; Brent R O'Neill; Roy W R Dudley; John Ragheb; Sanjiv Bhatia; Daniel Delev; Georgia Ramantani; Josef Zentner; Anthony C Wang; Christian Dorfer; Martha Feucht; Thomas Czech; Robert J Bollo; Galymzhan Issabekov; Hongwei Zhu; Mary Connolly; Paul Steinbok; Jian-Guo Zhang; Kai Zhang; Eveline Teresa Hidalgo; Howard L Weiner; Lily Wong-Kisiel; Samuel Lapalme-Remis; Manjari Tripathi; Poodipedi Sarat Chandra; Walter Hader; Feng-Peng Wang; Yi Yao; Pierre-Olivier Champagne; Tristan Brunette-Clément; Qiang Guo; Shao-Chun Li; Marcelo Budke; Maria Angeles Pérez-Jiménez; Christian Raftopoulos; Patrice Finet; Pauline Michel; Karl Schaller; Martin N Stienen; Valentina Baro; Christian Cantillano Malone; Juan Pociecha; Noelia Chamorro; Valeria L Muro; Marec von Lehe; Silvia Vieker; Chima Oluigbo; William D Gaillard; Mashael Al-Khateeb; Faisal Al Otaibi; Niklaus Krayenbühl; Jeffrey Bolton; Phillip L Pearl; Alexander G Weil Journal: Epilepsia Date: 2021-09-12 Impact factor: 6.740
Authors: Irene Wang; Sehong Oh; Ingmar Blümcke; Roland Coras; Balu Krishnan; Sanghoon Kim; Aaron McBride; Olesya Grinenko; Yicong Lin; Margit Overmyer; Tin Tun Aung; Mark Lowe; Mykol Larvie; Andreas V Alexopoulos; William Bingaman; Jorge A Gonzalez-Martinez; Imad Najm; Stephen E Jones Journal: Epilepsia Date: 2020-09-19 Impact factor: 5.864