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Garvayo M, Dupont S, Frazzini V, Bielle F, Adam C, Bendary YE, Méré M, Samson S, Guesdon A, Navarro V, Mathon B. Resective surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis in patients over 50 years: a case-control study. J Neurol 2024:10.1007/s00415-024-12599-4. [PMID: 39069564 DOI: 10.1007/s00415-024-12599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE/HS) is the most common cause of drug-resistant focal seizures and surgical resection is the primary treatment option, with seizure-free rates ranging from 60 to 80%. However, data on postsurgical seizure outcomes in patients ≥ 50 years of age are limited. This study aimed to assess the efficacy and safety of surgery in this age group compared to younger patients. METHODS We performed a retrospective analysis of data from resective surgeries conducted in patients with MTLE/HS between 1990 and 2022. We focused on patients aged ≥ 50 years and compared the surgical safety and efficacy variables between this group and a control group of patients aged < 50 years through a case-control study. RESULTS Among the 450 MTLE/HS patients who underwent surgery during the inclusion period, 61 (13.6%) were aged ≥ 50 years and matched with 183 younger patients, totaling 244 study participants. The two groups had similar characteristics. At the last follow-up (median 5.7 years), Engel I outcomes were achieved in 80.3% of the older patients and 81.4% of the younger patients, with no significant difference (p = 0.85). Postoperative cognitive and psychiatric outcomes did not differ between the groups. Major complication rates were also comparable, at 3.3% in the older group and 2.7% in the younger group (p = 0.83). The extratemporal ictal abnormalities observed on video-EEG were the only variable that demonstrated a significant association with an unfavorable seizure outcome in the older group (OR 9.3, 95% CI [1.8-47.6], p = 0.005). CONCLUSIONS This study provides grade 3 evidence that resective surgery for MTLE/HS patients aged ≥ 50 years is as effective and safe as it is for younger patients, and thus should be considered as the primary treatment option for drug-resistant cases.
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Affiliation(s)
- Marta Garvayo
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Sophie Dupont
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Valerio Frazzini
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France
| | - Franck Bielle
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France
- Department of Neuropathology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Claude Adam
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Yahia El Bendary
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Marie Méré
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Séverine Samson
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- ULR 4072 - PSITEC, University of Lille, Lille, France
- Institut Pasteur, INSERM, Institut de l'Audition, Université Paris Cité, Paris, France
| | - Alice Guesdon
- Department of Psychiatry, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Vincent Navarro
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France
| | - Bertrand Mathon
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France.
- Sorbonne Université, GRC 23, Brain Machine Interface, APHP, Paris, France.
- Robotics and Surgical Innovation, Sorbonne Université GRC 33, APHP, Paris, France.
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Athreya A, Matthews RE, Drane DL, Bonilha L, Willie JT, Gross RE, Karakis I. Withdrawal of antiseizure medications after MRI-Guided laser interstitial thermal therapy in extra-temporal lobe epilepsy. Seizure 2023; 110:86-92. [PMID: 37331198 DOI: 10.1016/j.seizure.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
PURPOSE This study investigated the success rate of antiseizure medications (ASMs) withdrawal following MRI Guided Laser Interstitial Thermal Therapy (MRg-LITT) for extra-temporal lobe epilepsy (ETLE), and identified predictors of seizure recurrence. METHODS We retrospectively assessed 27 patients who underwent MRg-LITT for ETLE. Patients' demographics, disease characteristics, and post-surgical outcomes were evaluated for their potential to predict seizure recurrence associated with ASMs withdrawal. RESULTS The median period of observation post MRg-LITT was 3 years (range 18 - 96 months) and the median period to initial ASMs reduction was 0.5 years (range 1-36 months). ASMs reduction was attempted in 17 patients (63%), 5 (29%) of whom had seizure recurrence after initial reduction. Nearly all patient who relapsed regained seizure control after reinstitution of their ASMs regimen. Pre-operative seizure frequency (p = 0.002) and occurrence of acute post-operative seizures (p = 0.01) were associated with increased risk for seizure recurrence post ASMs reduction. At the end of the observation period, 11% of patients were seizure free without drugs, 52% were seizure free with drugs and 37% still experienced seizures despite ASMs. Compared with pre-operative status, the number of ASMs was reduced in 41% of patients, unchanged in 55% of them and increased in only 4% of them. CONCLUSIONS Successful MRg-LITT for ETLE allows for ASMs reduction in a significant portion of patients and complete ASMs withdrawal in a subset of them. Patients with higher pre-operative seizure frequency or occurrence of acute post operative seizures exhibit higher chances relapse post ASMs reduction.
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Affiliation(s)
- Arjun Athreya
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca E Matthews
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Leonardo Bonilha
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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Salemdawod A, Wach J, Banat M, Borger V, Hamed M, Haberl H, Sassen R, Radbruch A, Becker AJ, Vatter H, Surges R, Sarikaya-Seiwert S. Predictors of postoperative long-term seizure outcome in pediatric patients with focal cortical dysplasia type II at a German tertiary epilepsy center. J Neurosurg Pediatr 2022; 29:83-91. [PMID: 34653986 DOI: 10.3171/2021.7.peds21219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) is a common cause of early-onset intractable epilepsy, and resection is a highly sufficient treatment option. In this study, the authors aimed to provide a retrospective analysis of pre- and postoperative factors and their impact on postoperative long-term seizure outcome. METHODS The postoperative seizure outcomes of 50 patients with a mean age of 8 ± 4.49 years and histologically proven FCD type II were retrospectively analyzed. Furthermore, pre- and postoperative predictors of long-term seizure freedom were assessed. The seizure outcome was evaluated based on the International League Against Epilepsy (ILAE) classification. RESULTS Complete resection of FCD according to MRI criteria was achieved in 74% (n = 37) of patients. ILAE class 1 at the last follow-up was achieved in 76% (n = 38) of patients. A reduction of antiepileptic drugs (AEDs) to monotherapy or complete withdrawal was achieved in 60% (n = 30) of patients. Twelve patients (24%) had a late seizure recurrence, 50% (n = 6) of which occurred after reduction of AEDs. A lower number of AEDs prior to surgery significantly predicted a favorable seizure outcome (p = 0.013, HR 7.63). Furthermore, younger age at the time of surgery, shorter duration of epilepsy prior to surgery, and complete resection were positive predictors for long-term seizure freedom. CONCLUSIONS The duration of epilepsy, completeness of resection, number of AEDs prior to surgery, and younger age at the time of surgery served as predictors of postoperative long-term seizure outcome, and, as such, may improve clinical practice when selecting and counseling appropriate candidates for resective epilepsy surgery. The study results also underscored that epilepsy surgery should be considered early in the disease course of pediatric patients with FCD type II.
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Affiliation(s)
| | | | | | | | - Motaz Hamed
- 1Department of Neurosurgery, University of Bonn
| | | | | | | | - Albert J Becker
- 5Institute of Neuropathology, University of Bonn, Bonn, Germany
| | | | - Rainer Surges
- 4Department of Epileptology, University of Bonn; and
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Athreya A, Fasano RE, Drane DL, Millis SR, Willie JT, Gross RE, Karakis I. Withdrawal of antiepileptic drugs after stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Epilepsy Res 2021; 176:106721. [PMID: 34273722 DOI: 10.1016/j.eplepsyres.2021.106721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This retrospective study investigated the success rate of withdrawal of antiepileptic drugs (AEDs) following stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE), and identified predictors of seizure recurrence. MATERIALS AND METHODS We retrospectively assessed 65 patients who underwent SLAH for MTLE (59 lesional). Patients' demographics, disease characteristics and post-surgical outcomes were evaluated for their potential to predict seizure recurrence associated with withdrawal of AEDs. RESULTS The mean period of observation post SLAH was 51 months (range 12-96 months) and the mean period to initial reduction of AEDs was 21 months (range 12-60 months). Reduction of AEDs was attempted in 37 patients (57 %) who were seizure free post SLAH and it was successful in approximately 2/3 of them. From the remainder 1/3 who relapsed, nearly all regained seizure control after reinstitution of their AEDs. The likelihood of relapse after reduction of AEDs was predicted only by pre-operative seizure frequency. At the end of the observation period, approximately 14 % of all SLAH patients were seizure free without AEDs and approximately 54 % remained seizure free on AEDs. Compared with preoperative status, the number of AEDs were reduced in 37 % of patients, unchanged in 51 % of them and increased in 12 % of them. CONCLUSIONS Successful SLAH for MTLE allows for reduction of AEDs in a significant portion of patients and complete withdrawal of AEDs in a subset of them. Patients with higher pre-operative seizure frequency exhibit a greater chance of relapse post reduction of AEDs.
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Affiliation(s)
- Arjun Athreya
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca E Fasano
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Scott R Millis
- Department of Neurology, Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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Castagno S, D'Arco F, Tahir MZ, Battey H, Eltze C, Moeller F, Tisdall M. Seizure outcomes of large volume temporo-parieto-occipital and frontal surgery in children with drug-resistant epilepsy. Epilepsy Res 2021; 177:106769. [PMID: 34560348 DOI: 10.1016/j.eplepsyres.2021.106769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In this study, we investigate the seizure outcomes of temporo-parieto-occipital (TPO) and frontal disconnections or resections in children with drug-resistant epilepsy (DRE) in order to determine factors which may predict surgical results. METHODS Children with DRE, who underwent either TPO or frontal disconnection or resection at Great Ormond Street Hospital for Children between 2000 and 2017, were identified from a prospectively collated operative database. Demographic data, age at surgery, type of surgery, scalp EEGs and operative histopathology were collected. Magnetic resonance imaging (MRI) was assessed to determine completeness of disconnection and presence of radiological lesion beyond the disconnection margins. Seizure outcome at 6, 12, and 24 months post-surgery was assessed using the Engel Scale (ES). Logistic regression was used to identify relationships between data variables and seizure outcome. RESULTS 46 children (males = 28, females = 18; age range 0.5-16.6 years) who underwent TPO (n = 32, including a re-do disconnection) or frontal disconnection or resection (n = 15) were identified. Patients in the TPO treatment group had more favourable seizure outcomes than those in the frontal treatment group (ES I-II in 56 %vs 47 % at 6 months, 52 % vs 46 % at 12 months). Presence of the lesion beyond disconnection boundaries and older age at the time of surgery were associated with poorer seizure outcome. Gender, surgery type, completeness of disconnection, scalp EEG findings and underlying pathology were not related to seizure outcome, but subgroup numbers were small. CONCLUSIONS Both TPO and frontal disconnection are effective treatments for selected children with posterior multi-lobar or diffuse frontal lobe epilepsy. Confinement of the MRI lesion within the disconnection margins and a younger age at surgery are associated with favourable seizure outcomes. Further studies are required to elucidate these findings.
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Affiliation(s)
| | - Felice D'Arco
- Great Ormond Street Hospital, Department of Radiology, London, WC1N 3JH, United Kingdom
| | - M Zubair Tahir
- Great Ormond Street Hospital, Department of Neurosurgery, London, WC1N 3JH, United Kingdom
| | - Heather Battey
- Imperial College London, Department of Mathematics, London, SW7 2AZ, United Kingdom
| | - Christin Eltze
- Great Ormond Street Hospital, Department of Neurology, London, WC1N 3JH, United Kingdom
| | - Friederike Moeller
- Great Ormond Street Hospital, Department of Neurology, London, WC1N 3JH, United Kingdom
| | - Martin Tisdall
- Great Ormond Street Hospital, Department of Neurosurgery, London, WC1N 3JH, United Kingdom
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Zhang C, Kwan P. The Concept of Drug-Resistant Epileptogenic Zone. Front Neurol 2019; 10:558. [PMID: 31214106 PMCID: PMC6555267 DOI: 10.3389/fneur.2019.00558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/09/2019] [Indexed: 12/01/2022] Open
Abstract
Resective surgery is the most effective way to treat drug-resistant epilepsy. Despite extensive pre-surgical evaluation, only 30–70% patients would become seizure-free after surgery. New approaches and strategies are needed to improve the outcome of epilepsy surgery. It is commonly observed in clinical practice that antiepileptic drugs (AEDs) could maintain seizure freedom in a large proportion of patients after surgery, who were uncontrolled before the operation. In some patients cessation of AEDs leads to seizure recurrence which, in most cases, can be controlled by resuming AEDs. These observations suggest that the surgery has converted the epilepsy from drug-resistant to drug-responsive, implying that the operation has removed the brain tissue accounting for pharmacoresistance, rather than the pathological substrate of epilepsy (at least not completely). Based on these observations, it is hypothesized that there is a drug-resistant epileptogenic zone (DREZ) which overlaps with the epileptogenic zone (EZ), and has both epileptogenic and drug-resistant properties. DREZ is necessary and sufficient to cause drug-resistant epilepsy, and its remove would render the epilepsy drug-responsive. Testing the hypothesis requires the development of new methods to define the DREZ, which may be used to guide surgical planning when the epileptogenic zone cannot be completely excised. This concept can also help understand the mechanisms of drug-resistant epilepsy, leading to new therapeutic strategies.
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Affiliation(s)
- Chunbo Zhang
- School of Pharmacy, Nanchang University, Nanchang, China
| | - Patrick Kwan
- Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, VIC, Australia.,Departments of Medicine and Neurology, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
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Postoperative seizure outcome and timing interval to start antiepileptic drug withdrawal: A retrospective observational study of non-neoplastic drug resistant epilepsy. Sci Rep 2018; 8:13782. [PMID: 30213952 PMCID: PMC6137227 DOI: 10.1038/s41598-018-31092-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/16/2018] [Indexed: 02/05/2023] Open
Abstract
This study aimed to investigate the impact of timing interval to start AED withdraw (TIW) after surgery on the seizure outcome in non-neoplastic drug resistant epilepsy (DRE). TIW were divided into three groups (respectively,<1 year, 1-<2 years, and ≥2 years). The seizure outcome at the different time points after starting AED withdrawal were compared among three groups. Other factors that related to seizure recurrence and TIW were included into the multiple analysis to investigate the predictors of seizure-free. Altogether, 205 patients were involved in the study. 102 individuals (50%) had seizure recurrence and 127 (62%) had seizure-free at the final follow up. 115 of them have attempted AED reduction and had not seizure recurrence before AED reduction. The rate of seizure-free had no significant difference among people with different TIW. Multiple analysis indicated that temporal surgery is a favorable predictor of seizure-free at the first year after starting AED withdrawal, and preoperative secondary generalized seizures is an unfavorable predictor of seizure-free at the final follow up. In patients with non-neoplastic DRE, TIW is not the mainly influence factor on seizure outcome, however, preoperative secondary generalized seizures and extra-temporal surgery are negatively associated with seizure-free.
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Rathore C, Jeyaraj MK, Dash GK, Wattamwar P, Baheti N, Sarma SP, Radhakrishnan K. Outcome after seizure recurrence on antiepileptic drug withdrawal following temporal lobectomy. Neurology 2018; 91:e208-e216. [PMID: 29925547 DOI: 10.1212/wnl.0000000000005820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 04/10/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the long-term outcome following seizure recurrence on antiepileptic drug (AED) withdrawal after anterior temporal lobectomy for mesial temporal lobe epilepsy. METHODS We retrospectively studied the AED profile of patients who had a minimum of 5 years of postoperative follow-up after anterior temporal lobectomy for mesial temporal lobe epilepsy. Only those patients with hippocampal sclerosis or normal MRI were included. AED withdrawal was initiated at 3 months in patients on ≥2 drugs and at 1 year for patients on a single drug. RESULTS Three hundred eighty-four patients with median postoperative follow-up of 12 years (range, 7-17 years) were included. Of them, 316 patients (82.3%) were seizure-free during the terminal 1 year. AED withdrawal was attempted in 326 patients (84.9%). At last follow-up, AEDs were discontinued in 207 patients (53.9%). Seizure recurrence occurred in 92 patients (28.2%) on attempted withdrawal. After a median postrecurrence follow-up of 7 years, 79 (86%) of them were seizure-free during the terminal 2 years. AEDs could be stopped in 17 patients (18.5%) and doses were reduced in another 57 patients (62%). Patients with febrile seizures, normal postoperative EEG at 1 year, and duration of epilepsy of <20 years (FND20 score) had 17% risk of seizure recurrence on attempted AED withdrawal. We also formulated a score to predict the chances of AED freedom for the whole cohort. CONCLUSION Patients with seizure recurrence on AED withdrawal have good outcome with 86% becoming seizure-free and 18% becoming drug-free after initial recurrence. A FND20 score helps in predicting recurrence on AED withdrawal.
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Affiliation(s)
- Chaturbhuj Rathore
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India.
| | - Malcolm K Jeyaraj
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
| | - Gopal K Dash
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
| | - Pandurang Wattamwar
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
| | - Neeraj Baheti
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
| | - Sankara P Sarma
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
| | - Kurupath Radhakrishnan
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
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Does early postoperative drug regimen impact seizure control in patients undergoing temporal lobe resections? J Neurol 2018; 265:500-509. [PMID: 29307009 DOI: 10.1007/s00415-017-8700-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/30/2017] [Accepted: 12/02/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the impact of postoperative antiepileptic drug (AED) load on seizure control in patients who underwent surgical treatment for pharmacoresistant mesiotemporal lobe epilepsy during the first two postoperative years. PATIENTS AND METHODS 532 consecutive patients (48.7% males and 51.7% females) who underwent surgical treatment for mesiotemporal lobe epilepsy were retrospectively evaluated regarding effects of AED load on seizures control during the first 2 years following epilepsy surgery. We analyzed whether postoperative increases in postoperative AED load are associated with better seizure control in patients initially not seizure free, and if postoperative decreases in postoperative AED load would increase the risk for seizure persistence or recurrence. For statistical analyses, Fisher's exact and Wilcoxon test were applied. RESULTS 68.9, 64.0 and 59.1% of patients were completely seizure free (Engel Ia) at 3, 12 and 24 months after surgery, respectively. Patients in whom daily drug doses were increased did not have a higher rate of seizure freedom at any of the three follow-up periods. Of 16 patients achieving secondary seizure control at 12 months after surgery, only one did so with an increase in drug load in contrast to 15 patients who experienced a running down of seizures independent of drug load increases. Decreases in drug load did not significantly increase the risk for seizure recurrence. Of postoperatively seizure free patients at 3 months after surgery in whom AED were consequently reduced, 85% remained completely seizure free at 1 year and 76% at 1 year after surgery, respectively, as opposed to 86% each when AED was not reduced (differences n.s.). Mean daily drug load was significantly lower in seizure free patients at 12 and 24 months compared to patients with ongoing seizures. CONCLUSION In this large patient cohort stratified to the epilepsy syndrome neither did a postoperative reduction in drug load significantly increase the risk for seizure relapse nor did increases in drug dosages lead to improved seizure control. Mean drug load was on average lower in seizure free- than non-seizure free patients at 12 and 24 months of follow-up. Secondary seizure control after initial postoperative seizures in > 90% of cases occurred as a running down, independent of an AED increase. Thus, the effect of the surgical intervention rather than the postoperative drug regimen was the key determinant for seizure control. This finding supports a curative role of temporal lobe surgery rather than an effect rendering the majority of patients' pharmacoresponsive with a critical role of the antiepileptic drug regime for seizure control.
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Ryzí M, Rektor I, Ošlejšková H, Novák Z, Hemza J, Chrastina J, Brázdil M. Response to "Failed epilepsy surgery: It is not too late". Epilepsy Res 2015; 113:153-4. [PMID: 25936620 DOI: 10.1016/j.eplepsyres.2015.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Michal Ryzí
- Brno Epilepsy Center, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Černopolní 9, Brno 625 00, Czech Republic.
| | - Ivan Rektor
- 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.
| | - Hana Ošlejšková
- Brno Epilepsy Center, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Černopolní 9, Brno 625 00, Czech Republic.
| | - Zdeněk Novák
- 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.
| | - Jan Hemza
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic.
| | - Jan Chrastina
- 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.
| | - Milan Brázdil
- 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.
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Wasade VS, Elisevich K, Tahir R, Smith B, Schultz L, Schwalb J, Spanaki-Varelas M. Long-term seizure and psychosocial outcomes after resective surgery for intractable epilepsy. Epilepsy Behav 2015; 43:122-7. [PMID: 25614128 DOI: 10.1016/j.yebeh.2014.11.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/06/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
Abstract
Resective surgery is considered an effective treatment for refractory localization-related epilepsy. Most studies have reported seizure and psychosocial outcomes of 2-5 years postsurgery and a few up to 10 years. Our study aimed to assess long-term (up to 15 years) postsurgical seizure and psychosocial outcomes at our epilepsy center. The Henry Ford Health System Corporate Data Store was accessed to identify patients who had undergone surgical resection for localization-related epilepsy from 1993 to 2011. Demographics including age at epilepsy onset and surgery, seizure frequency before surgery, and pathology were gathered from electronic medical records. Phone surveys were conducted from May 2012 to January 2013 to determine patients' current seizure frequency and psychosocial metrics including driving and employment status and use of antidepressants. Surgical outcomes were based on Engel's classification (classes I and II=favorable outcomes). McNemar's tests, chi-square tests, two sample t-tests, and Wilcoxon two sample tests were used to analyze the relationships of psychosocial and surgical outcomes with demographic and surgical characteristics. A total of 470 patients had resective epilepsy surgery, and of those, 50 (11%) had died since surgery. Of the remaining, 253 (60%) were contacted with mean follow-up of 10.6±5.0years (27% of patients had follow-up of 15 years or longer). Of the patients surveyed, 32% were seizure-free and 75% had a favorable outcome (classes I and II). Favorable outcomes had significant associations with temporal resection (78% temporal vs 58% extratemporal, p=0.01) and when surgery was performed after scalp EEG only (85% vs 65%, p<0.001). Most importantly, favorable and seizure-free outcome rates remained stable after surgery over long-term follow-up [i.e., <5 years (77%, 41%), 5-10 years (67%, 29%), 10-15 years (78%, 38%), and >15 years (78%, 26%)]. Compared to before surgery, patients at the time of the survey were more likely to be driving (51% vs 35%, p<0.001) and using antidepressants (30% vs 22%, p=0.013) but less likely to be working full-time (23% vs 42%, p<0.001). A large majority of patients (92%) considered epilepsy surgery worthwhile regardless of the resection site, and this was associated with favorable outcomes (favorable=98% vs unfavorable=74%, p<0.001). The findings suggest that resective epilepsy surgery yields favorable long-term postoperative seizure and psychosocial outcomes.
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Affiliation(s)
- Vibhangini S Wasade
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA.
| | - Kost Elisevich
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Rizwan Tahir
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Brien Smith
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Lonni Schultz
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Jason Schwalb
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Marianna Spanaki-Varelas
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
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Fauser S, Essang C, Altenmüller DM, Staack AM, Steinhoff BJ, Strobl K, Bast T, Schubert-Bast S, Stephani U, Wiegand G, Prinz M, Brandt A, Zentner J, Schulze-Bonhage A. Long-term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia 2014; 56:66-76. [PMID: 25495786 DOI: 10.1111/epi.12876] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) is currently recognized as the most common cause of neocortical pharmacoresistant epilepsy. Epilepsy surgery has become an increasingly successful treatment option. Herein, the largest patient cohort reported to date is analyzed regarding long-term outcome and factors relevant for long-term seizure control. METHODS Two hundred eleven children and adults undergoing epilepsy surgery for histologically proven FCD and a follow-up period of 2-12 years were analyzed regarding the longitudinal course of seizure control, effects of FCD type, localization, magnetic resonance imaging (MRI), timing of surgery, and postoperative antiepileptic treatment. RESULTS After 1 year, Engel class I outcome was achieved in 65% of patients and the percentage of seizure-free patients remained stable over the following (up to 12) years. Complete resection of the assumed epileptogenic area, lower age at surgery, and unilobar localization were positive prognostic indicators of long-term seizure freedom. Seizure recurrence was 12% after the first year, whereas 8% achieved late seizure freedom either following additional introduction of antiepileptic drugs (AEDs) (4%), a reoperation (2%), or a running down phenomenon (2%). Thirty-nine percent of patients had a reduction of AED from polytherapy to monotherapy or a complete cessation of AED treatment. Late seizure relapse was seen in nine patients during reduction of AEDs (i.e., in 12% of all patients with AED tapering); in four of them seizures persisted after reestablishment of antiepileptic medication. SIGNIFICANCE Postoperative long-term seizure outcome was favorable in patients with FCD and remained stable in 80% of patients after the first postoperative year. Several preoperative factors revealed to be predictive for the postoperative outcome and may help in the preoperative counseling of patients with FCD and in the selection of ideal candidates for epilepsy surgery.
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Management of antiepileptic drugs following epilepsy surgery: A meta-analysis. Epilepsy Res 2014; 108:765-74. [DOI: 10.1016/j.eplepsyres.2014.01.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 01/26/2014] [Indexed: 11/18/2022]
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Kanchanatawan B, Limothai C, Srikijvilaikul T, Maes M. Clinical predictors of 2-year outcome of resective epilepsy surgery in adults with refractory epilepsy: a cohort study. BMJ Open 2014; 4:e004852. [PMID: 24755212 PMCID: PMC4010813 DOI: 10.1136/bmjopen-2014-004852] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Resective epilepsy surgery is currently a standard treatment for intractable epilepsy. Seizure freedom and discontinuation of antiepileptic drugs are the ultimate goals of epilepsy treatment. This study was carried out to delineate (1) possible differences in the success rate of epilepsy surgery 6 and 24 months after surgery; and (2) the clinical predictors of a good response to surgery. SETTING This is a cohort study performed at a tertiary care unit of a university hospital. PARTICIPANTS In this cohort study, 189 adults with intractable epilepsy who underwent epilepsy surgery were included. We collected clinical data at three time points, that is, preoperative and 6 and 24 months after surgery. PRIMARY AND SECONDARY OUTCOME MEASURES Engel class I-IV classification was the primary outcome measure of epilepsy surgery. The authors statistically adjusted Engel class I-IV classification for postoperative changes in antiepileptic drugs and used this new classification as a secondary outcome variable. RESULTS The success rate was 78.8% 6 months after surgery and increased to 88.3% 24 months after surgery. This success rate was reflected not only by the reduced number of seizures postsurgery, but also by a reduced dosage and use of antiepileptic drugs. Logistic regression analysis showed that a successful outcome of surgery is predicted by having temporal rather than extratemporal lobe epilepsy and less than nine presurgery seizures per month, while a positive familial history of epilepsy, younger age and dysphoric symptoms, the first 3 months after surgery, significantly worsened the outcome of surgery. Duration of illness, age at onset, epilepsy location, type of lesions and the presence of psychosis were not significant in predicting treatment outcome. CONCLUSIONS These findings have clinical relevance in that a better selection of patients based on the significant clinical predictors will increase the success rate of epilepsy surgery and treatment.
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Affiliation(s)
- B Kanchanatawan
- Faculty of Medicine, Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - C Limothai
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - T Srikijvilaikul
- Department of Surgery, Prasat Neurological Institute, Bangkok, Thailand
| | - M Maes
- Faculty of Medicine, Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Deakin University, Geelong, Australia
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Hemb M, Palmini A, Paglioli E, Paglioli EB, Costa da Costa J, Azambuja N, Portuguez M, Viuniski V, Booij L, Nunes ML. An 18-year follow-up of seizure outcome after surgery for temporal lobe epilepsy and hippocampal sclerosis. J Neurol Neurosurg Psychiatry 2013; 84:800-5. [PMID: 23408065 DOI: 10.1136/jnnp-2012-304038] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the very long-term clinical outcome of surgery for mesial temporal lobe epilepsy and unilateral hippocampal sclerosis (MTLE/HS) without atypical features. The impact of surgical technique and postoperative reduction of medication on this outcome was investigated. DESIGN Prospective longitudinal cohort follow-up study for up to18 years. SETTING Epilepsy surgery centre in a university hospital. PATIENTS 108 patients who underwent unilateral MTLE/HS. INTERVENTION Surgery for MTLE/HS. MAIN OUTCOME MEASURE Engel classification (I). Clinical evaluations were based on systematic interviews in person or by phone. Kaplan-Maier survival curves estimated the probability of remaining seizure free. The impact of medication management in the postoperative outcome was analysed using Cox regression. RESULTS The probability of remaining completely seizure-free at 12 and 18 years after MTLE/HS surgery was 65% and 62%, respectively. The risk of having any recurrence was 22% during the first 24 months and increased 1.4% per year afterwards. Type of surgical technique (selective amygdalohippocampectomy vs anterior temporal lobectomy) did not impact on outcome. Remaining on antiepileptic drugs and history of generalised clonic seizure diminished the probability of remaining seizure free. CONCLUSIONS MTLE/HS surgery is able to keep patients seizure free for almost up to two decades. Removal of the neocortex besides the mesial portion of the temporal lobe does not lead to better chances of seizure control. These findings are applicable to the typical unilateral MTLE/HS syndrome and cannot be generalised for all types of TLE. Future longitudinal randomised controlled studies are needed to replicate these findings.
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Affiliation(s)
- Marta Hemb
- Serviço de Neurologia, Hospital São Lucas da PUCRS. Av. Ipiranga, 6690 #220 90610-000, Porto Alegre, RS, Brazil;
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