Michal Ryzí1, Milan Brázdil2, Zdeněk Novák3, Jan Hemza4, Jan Chrastina5, Hana Ošlejšková6, Ivan Rektor7, Robert Kuba8. 1. Brno Epilepsy Center, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Černopolní 9, Brno 625 00, Czech Republic. Electronic address: mryzi@fnbrno.cz. 2. Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic. Electronic address: milan.brazdil@fnusa.cz. 3. Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic. Electronic address: zdenek.novak@fnusa.cz. 4. Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic. Electronic address: jan.hemza@fnusa.cz. 5. Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic. Electronic address: jan.chrastina@fnusa.cz. 6. Brno Epilepsy Center, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Černopolní 9, Brno 625 00, Czech Republic. Electronic address: hoslej@fnbrno.cz. 7. Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic. Electronic address: ivan.rektor@fnusa.cz. 8. Brno Epilepsy Center, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Černopolní 9, Brno 625 00, Czech Republic; Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic. Electronic address: robert.kuba@fnusa.cz.
Abstract
PURPOSE: The primary aim of this study was to analyze the long-term outcomes of patients who were classified as Engel IV one year after resective epilepsy surgery. The secondary objectives were to evaluate the effectiveness of different treatment options and to examine the reasons that the patients did not undergo resective reoperation. METHODS: Our study was designed as a retrospective open-label investigation of the long-term outcomes of 34 patients (12% of all surgically treated patients) who were classified as Engel IV one year after epilepsy surgery. RESULTS: At the last follow-up visit (average of 7.6 ± 4.2 years after surgery), 12 of the 34 examined patients (35.3%) were still classified as Engel IV; 22 of the 34 patients (64.7%) were improved (Engel I-III). Of the 34 patients, 8 (23.5%) achieved an excellent outcome, classified as Engel I, 3 patients (8.8%) were classified as Engel II, and 11 patients (32.4%) as Engel III. The seizure outcome in the patients classified as Engel I was achieved by resective reoperation in 4; by a change in antiepileptic medication in 3 patients; and by vagus nerve stimulation (VNS) in 1 patient. The seizure outcome of Engel II was achieved by a change in antiepileptic medication in all 3 patients. Of the 34 patients, a total of 6 (17.6%) underwent resective reoperation only. The major reasons for this were the absence of a plausible hypothesis for invasive re-evaluation, the risk of postoperative deficit, and multifocal epilepsy in the rest of patients. CONCLUSION: Although the reoperation rate was relatively low in our series, we can achieve better or even excellent seizure outcomes using other procedures in patients for whom resective surgery initially failed.
PURPOSE: The primary aim of this study was to analyze the long-term outcomes of patients who were classified as Engel IV one year after resective epilepsy surgery. The secondary objectives were to evaluate the effectiveness of different treatment options and to examine the reasons that the patients did not undergo resective reoperation. METHODS: Our study was designed as a retrospective open-label investigation of the long-term outcomes of 34 patients (12% of all surgically treated patients) who were classified as Engel IV one year after epilepsy surgery. RESULTS: At the last follow-up visit (average of 7.6 ± 4.2 years after surgery), 12 of the 34 examined patients (35.3%) were still classified as Engel IV; 22 of the 34 patients (64.7%) were improved (Engel I-III). Of the 34 patients, 8 (23.5%) achieved an excellent outcome, classified as Engel I, 3 patients (8.8%) were classified as Engel II, and 11 patients (32.4%) as Engel III. The seizure outcome in the patients classified as Engel I was achieved by resective reoperation in 4; by a change in antiepileptic medication in 3 patients; and by vagus nerve stimulation (VNS) in 1 patient. The seizure outcome of Engel II was achieved by a change in antiepileptic medication in all 3 patients. Of the 34 patients, a total of 6 (17.6%) underwent resective reoperation only. The major reasons for this were the absence of a plausible hypothesis for invasive re-evaluation, the risk of postoperative deficit, and multifocal epilepsy in the rest of patients. CONCLUSION: Although the reoperation rate was relatively low in our series, we can achieve better or even excellent seizure outcomes using other procedures in patients for whom resective surgery initially failed.
Authors: Shennan A Weiss; Tomas Pastore; Iren Orosz; Daniel Rubinstein; Richard Gorniak; Zachary Waldman; Itzhak Fried; Chengyuan Wu; Ashwini Sharan; Diego Slezak; Gregory Worrell; Jerome Engel; Michael R Sperling; Richard J Staba Journal: Brain Commun Date: 2022-04-20
Authors: Max O Krucoff; Alvin Y Chan; Stephen C Harward; Shervin Rahimpour; John D Rolston; Carrie Muh; Dario J Englot Journal: Epilepsia Date: 2017-10-10 Impact factor: 5.864