scholarly journals Factors predicting 10-year seizure freedom after temporal lobe resection

2020 ◽  
Vol 33 (1) ◽  
pp. 50-61 ◽  
Author(s):  
Friedhelm C. Schmitt ◽  
H.‑Joachim Meencke
Keyword(s):  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Univariate Analysis ◽  
Class I ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Patient Counseling ◽  
Long Term Follow Up

Abstract Background Resective surgery is an established and evidence-based treatment approach in pharmacoresistant temporal lobe epilepsy (TLE). Extra-long-term follow-up data are important to allow for good patient counseling. So far, only few trials provide prospective or retrospective data exceeding 5 years. Objective This study aimed to present data of continuous seizure outcome over an extended time period, with a particular focus on patients who remained seizure free for 10 years. Methods We analyzed seizure outcome after epilepsy surgery for TLE in 46 consecutive patients, who were seen on an annual basis for 10 years in a single center (Epilepsy Center Berlin Brandenburg). Factors for remaining seizure free for 10 years were determined by univariate analysis. Results The class I outcome changed each year by 74–78%. Of the patients, 63% remained continuously in Engel class I (48% Engel Class IA for 10 years) for 10 years. Six patients were never seizure free (12.5%). After 10 years, 35% of the patients were cured (i.e., seizure-free without medication). A higher number of antiepileptic drugs and seizures before surgery as well as the indication for invasive presurgical monitoring were associated with “unsuccessful surgery.” Conclusion With almost half of the patients completely seizure free and more than a third “cured,” epilepsy surgery remains the mainstay of therapy for TLE patients. Analysis in larger cohorts with extra-long-term follow-up is needed to assess good prognostic factors and other postsurgical outcome issues such as neuropsychological, psychiatric, and psychosocial outcomes.

Long-term seizure outcome following surgery for dysembryoplastic neuroepithelial tumor

2006 ◽  
Vol 104 (1) ◽  
pp. 62-69 ◽  
Author(s):  
Chow Huat Chan ◽  
Richard G. Bittar ◽  
Gavin A. Davis ◽  
Renate M. Kalnins ◽  
Gavin C. A. Fabinyi
Keyword(s):  
Outcome Data ◽  
Temporal Lobectomy ◽  
Class I ◽  
Surgical Removal ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Seizure Outcome ◽  
Short Term ◽  
Long Term Follow Up

Object Resection of dysembryoplastic neuroepithelial tumor (DNET) is thought to result in favorable seizure outcome, but long-term follow-up data are scarce. The authors present a review of 18 patients who underwent surgical removal of a DNET: 12 via temporal lobectomy and six via lesionectomy. Methods The mean long-term follow up was 10.8 years (median 10.4 years, range 7.8 to 14.8 years), and results obtained during this time period were compared with previously reported short-term (mean 2.7 years) seizure outcome data. In the current study, 66.7% patients had an Engel Class I outcome and 55.6% had an Engel Class IA outcome compared with 77.8% and 55.6%, respectively. Temporal lobectomy (Engel Class I, 83.3%; Engel Class IA, 66.7%) led to a better seizure outcome than lesionectomy (Engel Classes I and IA, 33.3%). Two patients (11.1%) required repeated operation and both had an incomplete lesionectomy initially. Conclusions Results indicated that complete resection of a DNET leads to a favorable seizure outcome, with epilepsy cure in those who had experienced early postoperative seizure relief. Long-term seizure outcome after surgery is predictable based on the result of short-term follow up.

Long-term outcome of extratemporal epilepsy surgery among 154 adult patients

2008 ◽  
Vol 108 (4) ◽  
pp. 676-686 ◽  
Author(s):  
Alaa Eldin Elsharkawy ◽  
Friedrich Behne ◽  
Falk Oppel ◽  
Heinz Pannek ◽  
Reinhard Schulz ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Cox Regression ◽  
Adult Patients ◽  
Class I ◽  
Seizure Outcome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Factors Associated

Object The goal of this study was to evaluate the long-term outcome of patients who underwent extratemporal epilepsy surgery and to assess preoperative prognostic factors associated with seizure outcome. Methods This retrospective study included 154 consecutive adult patients who underwent epilepsy surgery at Bethel Epilepsy Centre, Bielefeld, Germany between 1991 and 2001. Seizure outcome was categorized based on the modified Engel classification. Survival statistics were calculated using Kaplan–Meier curves, life tables, and Cox regression models to evaluate the risk factors associated with outcomes. Results Sixty-one patients (39.6%) underwent frontal resections, 68 (44.1%) had posterior cortex resections, 15 (9.7%) multilobar resections, 6 (3.9%) parietal resections, and 4 (2.6%) occipital resections. The probability of an Engel Class I outcome for the overall patient group was 55.8% (95% confidence interval [CI] 52–58% at 0.5 years), 54.5% (95% CI 50–58%) at 1 year, and 51.1% (95% CI 48–54%) at 14 years. If a patient was in Class I at 2 years postoperatively, the probability of remaining in Class I for 14 years postoperatively was 88% (95% CI 78–98%). Factors predictive of poor long-term outcome after surgery were previous surgery (p = 0.04), tonic–clonic seizures (p = 0.02), and the presence of an auditory aura (p = 0.03). Factors predictive of good long-term outcome were surgery within 5 years after onset (p = 0.015) and preoperative invasive monitoring (p = 0.002). Conclusions Extratemporal epilepsy surgery is effective according to findings on long-term follow-up. The outcome at the first 2-year follow-up visit is a reliable predictor of long-term Engel Class I postoperative outcome.

Early and late epilepsy surgery in focal epilepsies associated with long-term epilepsy-associated tumors

2017 ◽  
Vol 127 (5) ◽  
pp. 1147-1152 ◽  
Author(s):  
Veronica Pelliccia ◽  
Francesco Deleo ◽  
Francesca Gozzo ◽  
Ivana Sartori ◽  
Roberto Mai ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Focal Epilepsy ◽  
Large Population ◽  
Complete Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Determinant Factors ◽  
Associated Tumors

OBJECTIVEEpilepsy surgery is an effective means of treating focal epilepsy associated with long-term epilepsy-associated tumors. This study evaluated a large population of surgically treated patients with childhood onset of epilepsy and a histologically confirmed diagnosis of long-term epilepsy-associated tumors. The authors analyzed long-term seizure outcomes to establish whether the time of surgery and patients' ages were determinant factors.METHODSThe authors separately investigated several presurgical, surgical, and postsurgical variables in patients operated on before (pediatric group) and at or after (adult group) the age of 18 years. Patients with < 24 months of postsurgical follow-up were excluded from the analysis.RESULTSThe patients who underwent surgery before 18 years of age showed better seizure outcomes than those after 18 years of age (80% vs 53.3% Engel Class Ia outcome, respectively; p < 0.001). Multivariate analysis showed that the only variables significantly associated with seizure freedom were complete resection of the lesion, a shorter duration of epilepsy, and temporal lobe resection.CONCLUSIONSThe findings of this study indicate that pediatric patients are more responsive to epilepsy surgery and that a shorter duration of epilepsy, complete resection, and a temporal lobe localization are determinant factors for a positive seizure outcome.

scholarly journals Mesial temporal lobe epilepsy: long-term seizure outcome of patients primarily treated with transsylvian selective amygdalohippocampectomy

2018 ◽  
Vol 129 (1) ◽  
pp. 174-181 ◽  
Author(s):  
Christian Dorfer ◽  
Thomas Czech ◽  
Susanne Aull-Watschinger ◽  
Christoph Baumgartner ◽  
Rebekka Jung ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Class I ◽  
Seizure Outcome ◽  
Selective Amygdalohippocampectomy ◽  
Class 1 ◽  
Mesial Temporal Lobe

OBJECTIVEThe aim of this study was to present long-term seizure outcome data in a consecutive series of patients with refractory mesial temporal lobe epilepsy primarily treated with transsylvian selective amygdalohippocampectomy (SAHE).METHODSThe authors retrospectively analyzed prospectively collected data for all patients who had undergone resective surgery for medically refractory epilepsy at their institution between July 1994 and December 2014. Seizure outcome was assessed according to the International League Against Epilepsy (ILAE) and the Engel classifications.RESULTSThe authors performed an SAHE in 158 patients (78 males, 80 females; 73 right side, 85 left side) with a mean age of 37.1 ± 10.0 years at surgery. Four patients lost to follow-up and 1 patient who committed suicide were excluded from analysis. The mean follow-up period was 9.7 years. At the last available follow-up (or before reoperation), 68 patients (44.4%) had achieved an outcome classified as ILAE Class 1a, 46 patients (30.1%) Class 1, 6 patients (3.9%) Class 2, 16 patients (10.4%) Class 3, 15 patients (9.8%) Class 4, and 2 patients (1.3%) Class 5. These outcomes correspond to Engel Class I in 78.4% of the patients, Engel Class II in 10.5%, Engel Class III in 8.5%, and Engel Class IV in 2.0%. Eleven patients underwent a second surgery (anterior temporal lobectomy) after a mean of 4.4 years from the SAHE (left side in 6 patients, right side in 5). Eight (72.7%) of these 11 patients achieved seizure freedom.The overall ILEA seizure outcome since (re)operation after a mean follow-up of 10.0 years was Class 1a in 72 patients (47.0%), Class 1 in 50 patients (32.6%), Class 2 in 7 patients (4.6%), Class 3 in 15 patients (9.8%), Class 4 in 8 patients (5.2%), and Class 5 in 1 patient (0.6%). These outcomes correspond to an Engel Class I outcome in 84.3% of the patients.CONCLUSIONSA satisfactory long-term seizure outcome following transsylvian SAHE was demonstrated in a selected group of patients with refractory temporal lobe epilepsy.

Determinants of seizure outcome after resective surgery following stereoelectroencephalography

2021 ◽  
pp. 1-9
Author(s):  
Juan C. Bulacio ◽  
James Bena ◽  
Piradee Suwanpakdee ◽  
Dileep Nair ◽  
Ajay Gupta ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Univariate Analysis ◽  
Cleveland Clinic ◽  
Secondary Outcome ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Outcome Predictors ◽  
Seizure Recurrence ◽  
Resective Surgery

OBJECTIVE The aim of this study was to investigate seizure outcomes after resective epilepsy surgery following stereoelectroencephalography (SEEG), including group characteristics, comparing surgical and nonsurgical groups and assess predictors of time to seizure recurrence. METHODS Clinical and EEG data of 536 consecutive patients who underwent SEEG at Cleveland Clinic Epilepsy Center between 2009 and 2017 were reviewed. The primary outcome was defined as complete seizure freedom since the resective surgery, discounting any auras or seizures that occurred within the 1st postoperative week. In addition, the rate of seizure freedom based on Engel classification was determined in patients with follow-up of ≥ 1 year. Presumably significant outcome variables were first identified using univariate analysis, and Cox proportional hazards modeling was used to identify outcome predictors. RESULTS Of 527 patients satisfying study criteria, 341 underwent resective surgery. Complete and continuous seizure freedom after surgery was achieved in 55.5% of patients at 1 year postoperatively, 44% of patients at 3 years, and 39% of patients at 5 years. As a secondary outcome point, 58% of patients achieved Engel class I seizure outcome for at least 1 year at last follow-up. Among surgical outcome predictors, in multivariate model analysis, the seizure recurrence rate by type of resection (p = 0.039) remained statistically significant, with the lowest risk of recurrence occurring after frontal and temporal lobe resections compared with multilobar and posterior quadrant surgeries. Patients with a history of previous resection (p = 0.006) and bilateral implantations (p = 0.023) were more likely to have seizure recurrence. The absence of an MRI abnormality prior to resective surgery did not significantly affect seizure outcome in this cohort. CONCLUSIONS This large, single-center series shows that resective surgery leads to continuous seizure freedom in a group of patients with complex and severe pharmacoresistant epilepsy after SEEG evaluation. In addition, up to 58% of patients achieved seizure freedom at last follow-up. The authors’ results suggest that SEEG is equally effective in patients with frontal and temporal lobe epilepsy with or without MRI identified lesions.

Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis

2006 ◽  
Vol 104 (4) ◽  
pp. 513-524 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Brian G. Wilhelmi ◽  
Frederic Collignon ◽  
J. Bradley White ◽  
Jeffrey W. Britton ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Class I ◽  
Seizure Outcome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Kaplan Meier ◽  
The Mean ◽  
Mesial Temporal Lobe

Object The authors reviewed the long-term outcome of focal resection in a large group of patients who had intractable partial nonlesional epilepsy, including mesial temporal lobe sclerosis (MTS), and who were treated consecutively at a single institution. The goal of this study was to evaluate the long-term efficacy of epilepsy surgery and the preoperative factors associated with seizure outcome. Methods This retrospective analysis included 399 consecutive patients who underwent epilepsy surgery at Mayo Clinic in Rochester, Minnesota, between 1988 and 1996. The mean age of the patients at surgery was 32 ± 12 years (range 3–69 years), and the mean age at seizure onset was 12 ± 11 years (range 0–55 years). There were 214 female (54%) and 185 male (46%) patients. The mean duration of epilepsy was 20 ±12 years (range 1–56 years). The preceding values are given as the mean ± standard deviation. Of the 399 patients, 237 (59%) had a history of complex partial seizures, 119 (30%) had generalized seizures, 26 (6%) had simple partial seizures, and 17 (4%) had experienced a combination of these. Preoperative evaluation included a routine and video-electroencephalography recordings, magnetic resonance imaging of the head according to the seizure protocol, neuropsychological testing, and a sodium amobarbital study. Patients with an undefined epileptogenic focus and discordant preoperative studies underwent an intracranial study. The mean duration of follow up was 6.2 ± 4.5 years (range 0.6–15.7 years). Seizure outcome was categorized based on the modified Engel classification. Time-to-event analysis was performed using Kaplan–Meier curves and Cox regression models to evaluate the risk factors associated with outcomes. Among these patients, 372 (93%) underwent temporal and 27 (7%) had extratemporal resection of their epileptogenic focus. Histopathological examination of the resected specimens revealed MTS in 113 patients (28%), gliosis in 237 (59%), and normal findings in 49 (12%). Based on the Kaplan–Meier analysis, the probability of an Engel Class I outcome (seizure free, auras, or seizures related only to medication withdrawal) for the overall patient group was 81% (95% confidence interval [CI] 77–85%) at 6 months, 78% (CI 74–82%) at 1 year, 76% (CI 72–80%) at 2 years, 74% (CI 69–78%) at 5 years, and 72% (CI 67–77%) at 10 years postoperatively. The rate of Class I outcomes remained 72% for 73 patients with more than 10 years of follow up. If a patient was in Class I at 1 year postoperatively, the probability of seizure remission at 10 years postoperatively was 92% (95% CI 89–96%); almost all seizures occurred during the 1st year after surgery. Factors predictive of poor outcome from surgery were normal pathological findings in resected tissue (p = 0.038), male sex (p = 0.035), previous surgery (p < 0.001), and an extratemporal origin of seizures (p < 0.001). Conclusions The response to epilepsy surgery during the 1st follow-up year is a reliable indicator of the long-term Engel Class I postoperative outcome. This finding may have important implications for patient counseling and postoperative discontinuation of anticonvulsant medications.

scholarly journals Surgery for temporal lobe epilepsy associated with mesial temporal sclerosis in the older patient: A long-term follow-up

Epilepsia ◽  
2010 ◽  
Vol 51 (6) ◽  
pp. 1024-1029 ◽  
Author(s):  
Michael Murphy ◽  
Paul D. Smith ◽  
Martin Wood ◽  
Stephen Bowden ◽  
Terence J. O’Brien ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Sclerosis ◽  
Older Patient ◽  
Long Term Follow Up

scholarly journals The proportion of seizure onset zone contacts resected is not associated with outcome following SEEG-guided resective epilepsy surgery in children

2021 ◽  
Author(s):  
Mehdi Khan ◽  
Aswin Chari ◽  
Kiran Seunarine ◽  
Christin Eltze ◽  
Friederike Moeller ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Univariate Analysis ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Imaging Data ◽  
Seizure Onset ◽  
Binary Logistic Regression Model ◽  
Primary Analysis ◽  
Seizure Onset Zone

AbstractPurposeChildren undergoing stereoelectroencephalography (SEEG)-guided epilepsy surgery represent a complex cohort. We aimed to determine whether the proportion of putative seizure onset zone (SOZ) contacts resected associates with seizure outcome in a cohort of children undergoing SEEG-guided resective epilepsy surgery.MethodsPatients who underwent SEEG-guided resective surgery over a six-year period were included. The proportion of SOZ contacts resected was determined by co-registration of pre- and post-operative imaging. Seizure outcomes were classified as seizure free (SF, Engel class I) or not seizure-free (NSF, Engel class II-IV) at last clinical follow-up.ResultsOf 94 patients undergoing SEEG, 29 underwent subsequent focal resection of whom 22 had sufficient imaging data to be included in the primary analysis (median age at surgery of 10 years, range 5-18). Fifteen (68.2%) were SF and 7 (31.8%) NSF at median follow-up of 19.5 months (range 12-46). On univariate analysis, histopathology, was the only significant factor associated with SF (p<0.05). The percentage of defined SOZ contacts resected ranged from 25-100% and was not associated with SF (p=0.89). In a binary logistic regression model, it was highly likely that histology was the only independent predictor of outcome, although the interpretation was limited by pseudo-complete separation of the data.ConclusionHistopathology is a significant predictor of surgical outcomes in children undergoing SEEG-guided resective epilepsy surgery. The percentage of SOZ contacts resected was not associated with SF. Factors such as spatial organisation of the epileptogenic zone, neurophysiological biomarkers and the prospective identification of pathological tissue may therefore play an important role.

scholarly journals Results of Epilepsy Surgery: Still So Much to Learn

2006 ◽  
Vol 6 (3) ◽  
pp. 80-82
Author(s):  
Donna C. Bergen
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Epilepsy Surgery ◽  
Disease Duration ◽  
Seizure Freedom ◽  
Hippocampal Atrophy ◽  
Younger Age ◽  
Seizure Relapse ◽  
Clonic Seizures

Predicting Long-Term Seizure Outcome after Resective Epilepsy Surgery: The Multicenter Study Spencer SS, Berg AT, Vickrey BG, Sperling MR, Bazil CW, Shinnar S, Langfitt JT, Walczak TS, Pacia SV Neurology 2005;65(6):912–918 Background In a seven-center prospective observational study of resective epilepsy surgery, the authors examined probability and predictors of entering 2-year remission and the risk of subsequent relapse. Methods Patients aged 12 years and over were enrolled at time of referral for epilepsy surgery, and underwent standardized evaluation, treatment, and follow-up procedures. The authors defined seizure remission as 2 years completely seizure-free after hospital discharge with or without auras, and relapse as any seizures after 2-year remission. The authors examined type of surgery, seizure, clinical and demographic variables, and localization study results with respect to prediction of seizure remission or relapse, using χ2 and proportional hazards analysis. Results Of 396 operated patients, 339 were followed over 2 years, and 223 (66%) experienced 2-year remission, not significantly different between medial temporal (68%) and neocortical (50%) resections. In multivariable models, only absence of generalized tonic–clonic seizures and presence of hippocampal atrophy were significantly and independently associated with remission, and only in the medial temporal resection group. Fifty-five patients relapsed after 2-year remission, again not significantly different between medial temporal (25%) and neocortical (19%) resections. Only delay to remission predicted relapse, and only in medial temporal patients. Conclusion Hippocampal atrophy and a history of absence of generalized tonic clonic seizures were the sole predictors of 2-year remission, and only for medial temporal resections. Antiepileptic Drug Withdrawal after Successful Surgery for Intractable Temporal Lobe Epilepsy Kim YD, Heo K, Park SC, Huh K, Chang JW, Choi JU, Chung SS, Lee BI Epilepsia 2005;46(2):251–257 Purpose To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy. Methods The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for ≥1 year during the follow-up period. Results Sixty-six (75%) patients achieved complete seizure freedom for ≥1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction ( n = 60), and in 7 (12%) patients after discontinuation of AEDs ( n = 38). The seizure recurrence rate was not different between the immediate- and delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, 9 (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in 6 of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs 23%). At the final assessment, 54 (61%) patients had been seizure free ≥1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration. Conclusions Our results suggest that seizure freedom without aura at ≥1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period.

Cushing and epilepsy surgery: Two successfully treated cases with long-term follow-up

1989 ◽  
Vol 32 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Matthew R. Moore ◽  
Eugene Rossitch ◽  
John Shillito
Keyword(s):  
Epilepsy Surgery ◽  
Long Term Follow Up
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