scholarly journals Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study

Neurosurgery ◽  
2019 ◽  
Vol 87 (4) ◽  
pp. 704-711 ◽  
Author(s):  
Johan Bjellvi ◽  
Anna Edelvik Tranberg ◽  
Bertil Rydenhag ◽  
Kristina Malmgren
Keyword(s):  
Risk Factors ◽  
Intellectual Disability ◽  
Seizure Frequency ◽  
Epilepsy Surgery ◽  
Neurological Deficit ◽  
Age Of Onset ◽  
Multivariable Analysis ◽  
Seizure Outcome ◽  
Age At Surgery ◽  
New Onset

Abstract BACKGROUND Increased seizure frequency and new-onset tonic-clonic seizures (TCS) have been reported after epilepsy surgery. OBJECTIVE To analyze potential risk factors for these outcomes in a large cohort. METHODS We studied prospectively collected data in the Swedish National Epilepsy Surgery Register on increased seizure frequency and new-onset TCS after epilepsy surgery 1990-2015. RESULTS Two-year seizure outcome was available for 1407 procedures, and data on seizure types for 1372. Increased seizure frequency at follow-up compared to baseline occurred in 56 cases (4.0%) and new-onset TCS in 53 (3.9%; 6.6% of the patients without preoperative TCS). Increased frequency was more common in reoperations compared to first surgeries (7.9% vs 3.1%; P = .001) and so too for new-onset TCS (6.7% vs 3.2%; P = .017). For first surgeries, binary logistic regression was used to analyze predictors for each outcome. In univariable analysis, significant predictors for increased seizure frequency were lower age of onset, lower age at surgery, shorter epilepsy duration, preoperative neurological deficit, intellectual disability, high preoperative seizure frequency, and extratemporal procedures. For new-onset TCS, significant predictors were preoperative deficit, intellectual disability, and nonresective procedures. In multivariable analysis, independent predictors for increased seizure frequency were lower age at surgery (odds ratio (OR) 0.70 per increasing 10-yr interval, 95% CI 0.53-0.93), type of surgery (OR 0.42 for temporal lobe resections compared to other procedures, 95% CI 0.19-0.92), and for new-onset TCS preoperative neurological deficit (OR 2.57, 95% CI 1.32-5.01). CONCLUSION Seizure worsening is rare but should be discussed when counseling patients. The identified risk factors may assist informed decision-making before surgery.

The Risk of Seizure Recurrence After a First Unprovoked Afebrile Seizure in Childhood: An Extended Follow-up

PEDIATRICS ◽  
1996 ◽  
Vol 98 (2) ◽  
pp. 216-225 ◽  
Author(s):  
Shlomo Shinnar ◽  
Anne T. Berg ◽  
Solomon L. Moshe ◽  
Christine O'Dell ◽  
Marta Alemany ◽  
...  
Keyword(s):  
Risk Factors ◽  
Age Of Onset ◽  
Multivariable Analysis ◽  
Cumulative Risk ◽  
Febrile Seizures ◽  
Recurrence Risk ◽  
Early Recurrence ◽  
Seizure Recurrence ◽  
Unprovoked Seizure ◽  
History Of

Objective. To assess the long-term recurrence risks after a first unprovoked seizure in childhood. Methods. In a prospective study, 407 children who presented with a first unprovoked seizure were then followed for a mean of 6.3 years from the time of first seizure. Results. One hundred seventy-one children (42%) experienced subsequent seizures. The cumulative risk of seizure recurrence was 29%,37%,42%, and 44% at 1,2,5, and 8 years, respectively. The median time to recurrence was 5.7 months, with 53% of recurrences occurring within 6 months, 69% within 1 year, and 88% within 2 years. Only 5 recurrences (3%) occurred after 5 years. On multivariable analysis, risk factors for seizure recurrence included a remote symptomatic etiology, an abnormal electroencephalogram (EEG), a seizure occurring while asleep, a history of prior febrile seizures, and Todd's paresis. In cryptogenic cases, the risk factors were an abnormal EEG and an initial seizure during sleep. In remote symptomatic cases, risk factors were a history of prior febrile seizures and age of onset younger than 3 years. Risk factors for late recurrences (after 2 years) were etiology, an abnormal EEG, and prior febrile seizures in the overall group and an abnormal EEG in the cryptogenic group. These are similar to the risk factors for early recurrence. Conclusions. The majority of children with a first unprovoked seizure will not have recurrences. Children with cryptogenic first seizures and a normal EEG whose initial seizure occurs while awake have a particularly favorable prognosis, with a 5-year recurrence risk of only 21%. Late recurrences do occur but are uncommon.

The degenerative changes of the sacroiliac joint after S2 alar-iliac screw placement

2021 ◽  
pp. 1-7
Author(s):  
Norimasa Ikeda ◽  
Shunsuke Fujibayashi ◽  
Bungo Otsuki ◽  
Kazutaka Masamoto ◽  
Takayoshi Shimizu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Bone Formation ◽  
Sacroiliac Joint ◽  
Safe Procedure ◽  
Multivariate Logistic Regression ◽  
Age At Surgery ◽  
Iliac Screw ◽  
New Onset

OBJECTIVE The goal of this study was to investigate clinical outcomes and risk factors for the progression of sacroiliac joint (SIJ) degeneration and bone formation after S2 alar-iliac screw (S2AIS) insertion. METHODS Using preoperative and follow-up CT scan findings (median follow-up 26 months, range 16–43 months), the authors retrospectively studied 100 SIJs in 50 patients who underwent S2AIS placement. The authors measured the progression of SIJ degeneration and bone formation after S2AIS insertion, postoperative new-onset SIJ pain, S2AIS-related reoperation, and instrumentation failures. Stepwise multivariate logistic regression modeling was performed to clarify the risk factors associated with the progression of SIJ degeneration. RESULTS Significant progression of SIJ degeneration was observed in 10% of the group with preoperative SIJ degeneration (p = 0.01). Bone formation was observed in 6.9% of joints. None of the patients with these radiographic changes had new-onset SIJ pain or underwent reoperation related to instrumentation failures. Multivariate logistic regression analysis revealed that preoperative SIJ degeneration (p < 0.01) and a young age at surgery (p = 0.03) significantly affected the progression of SIJ degeneration. CONCLUSIONS The progression of SIJ degeneration and bone formation neither led to major screw-related complications nor affected the postoperative clinical course during the median follow-up period of 26 months. Although S2AIS insertion is a safe procedure for most patients, the results of this study suggested that preoperative degeneration and younger age at surgery affected SIJ degeneration after S2AIS insertion. Further long-term observation may reveal other effects of S2AIS insertion on SIJ degeneration.

scholarly journals Long-term seizure outcome and risk factors for recurrence after extratemporal epilepsy surgery

Epilepsia ◽  
2012 ◽  
Vol 53 (6) ◽  
pp. 970-978 ◽  
Author(s):  
Anne M. McIntosh ◽  
Clare A. Averill ◽  
Renate M. Kalnins ◽  
L. Anne Mitchell ◽  
Gavin C. A. Fabinyi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Epilepsy Surgery ◽  
Seizure Outcome ◽  
Risk Factors For Recurrence

scholarly journals Epilepsy surgery in tuberous sclerosis complex: the BC Children’s Hospital experience

2015 ◽  
Vol 42 (S1) ◽  
pp. S14-S14
Author(s):  
C Wilbur ◽  
C Sanguansermsri ◽  
H Chable ◽  
A Mihaela ◽  
P Steinbok ◽  
...  
Keyword(s):  
Tuberous Sclerosis ◽  
Epilepsy Surgery ◽  
Tuberous Sclerosis Complex ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Seizure Outcome ◽  
Corpus Callosotomy ◽  
Age At Surgery ◽  
Second Resection

Background: Epilepsy occurs in up to 90% of patients with Tuberous Sclerosis Complex (TSC) and is often refractory to medications. Our objective was to assess the safety and outcome of epilepsy surgery in children with TSC at our institution. Methods: We performed a systematic, retrospective chart review of children with TSC who underwent epilepsy surgery at our institution. Patients were identified through epilepsy and clinical neurophysiology databases. Results: 19 patients (out of 81 with TSC) underwent surgery between 1995-2014. Median age at surgery was 4.2 (Range 1.1-15.6) years, with patients having failed a median 4 (Range 0-10) anti-seizure medications. Surgery comprised corpus callosotomy in 2 and resection of one or more tubers in 17. 2 patients had a subsequent second resection. Minor neurologic deficits occurred after 14% of surgeries. Median follow-up was 2.4 years (Range 0.3 -13.8 years) following surgery . At last follow-up, 47% were seizure free, including 2 patients off anti-seizure medication. Conclusions: Epilepsy surgery is safe and effective in carefully selected TSC patients, with the majority having a good seizure outcome. Children with epilepsy secondary to TSC should be referred for epilepsy surgery assessment.

scholarly journals Severity Grading, Risk Factors, and Prediction Model of Complications After Epilepsy Surgery: A Large-Scale and Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yong Liu ◽  
Hao Wu ◽  
Huanfa Li ◽  
Shan Dong ◽  
Xiaofang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Prediction Model ◽  
Epilepsy Surgery ◽  
Odds Ratio ◽  
Surgical Procedure ◽  
Multivariable Logistic Regression Analysis ◽  
Age At Surgery ◽  
Severity Grading ◽  
Surgery Duration

Purpose: To report complications after epilepsy surgery, grade the severity of complications, investigate risk factors, and develop a nomogram for risk prediction of complications.Methods: Patients with epilepsy surgery performed by a single surgeon at a single center between October 1, 2003 and April 30, 2019 were retrospectively analyzed. Study outcomes included severity grading of complications occurring during the 3-month period after surgery, risk factors, and a prediction model of these complications. Multivariable logistic regression analysis was used to calculate odds ratio and 95% confidence interval to identify risk factors.Results: In total, 2,026 surgical procedures were eligible. There were 380 patients with mild complications, 23 with moderate complications, and 82 with severe complications. Being male (odds ratio 1.29, 95% confidence interval 1.02–1.64), age at surgery (&gt;40 years: 2.58, 1.55–4.31; ≤ 40: 2.25, 1.39–3.65; ≤ 30: 1.83, 1.18–2.84; ≤ 20: 1.71, 1.11–2.63), intracranial hemorrhage in infancy (2.28, 1.14–4.57), serial number of surgery ( ≤ 1,000: 1.41, 1.01–1.97; ≤ 1,500: 1.63, 1.18–2.25), type of surgical procedure (extratemporal resections: 2.04, 1.55–2.70; extratemporal plus temporal resections: 2.56, 1.80–3.65), surgery duration (&gt;6 h: 1.94, 1.25–3.00; ≤ 6: 1.92, 1.39–2.65), and acute postoperative seizure (1.44, 1.06–1.97) were independent risk factors of complications. A nomogram including age at surgery, type of surgical procedure, and surgery duration was developed to predict the probability of complications.Conclusions: Although epilepsy surgery has a potential adverse effect on the patients, most complications are mild and severe complications are few. Risk factors should be considered during the perioperative period. Patients with the above risk factors should be closely monitored to identify and treat complications timely. The prediction model is very useful for surgeons to improve postoperative management.

Seizure outcomes in children with Rasmussen’s encephalitis undergoing resective or hemispheric epilepsy surgery: an individual participant data meta-analysis

2020 ◽  
Vol 25 (3) ◽  
pp. 274-283
Author(s):  
William B. Harris ◽  
H. Westley Phillips ◽  
Jia Shu Chen ◽  
Alexander G. Weil ◽  
George M. Ibrahim ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Meta Analysis ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Individual Participant Data ◽  
Rasmussen’S Encephalitis ◽  
Younger Age ◽  
Age At Surgery ◽  
Individual Participant ◽  
Preoperative Factors

OBJECTIVEThe objective of this study was to perform an individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Rasmussen’s encephalitis (RE) undergoing resective or hemispheric epilepsy surgery.METHODSElectronic databases (PubMed, Web of Science, CINAHL) were searched with no language or date restrictions to identify cohort studies of consecutive participants undergoing resective surgery that reported seizure outcomes. The authors recorded all preoperative factors that could plausibly be associated with seizure outcomes and used Cox regression analysis to identify which of these variables were associated with seizure freedom (i.e., Engel class I).RESULTSOf 720 citations, 19 articles reporting on 187 participants were eligible. Seizure freedom (Engel class I) was observed in 113 participants (60.4%). On univariate analyses, younger age at disease onset (hazard ratio [HR] 0.906, p = 0.001), younger age at surgery (HR 0.928, p < 0.001), shorter time to surgery (HR 0.921, p = 0.001), and hemispherectomy (HR 0.283, p < 0.001) were all associated with longer time to postoperative seizure recurrence. Additionally, multivariable analysis including the aforementioned variables showed that younger age at surgery (HR 0.946, p = 0.043) and hemispherectomy (HR 0.297, p < 0.001) were independently and significantly associated with a greater time to seizure recurrence and longer duration of seizure freedom.CONCLUSIONSThe majority of pediatric patients undergoing resective or hemispheric surgery for RE achieve good seizure outcome. Although small retrospective cohort studies are inherently prone to bias, the best available evidence utilizing individual participant data suggests hemispheric surgery and younger age at surgery are associated with good seizure outcomes following epilepsy surgery. Large, multicenter observational studies with long-term follow-up are required to evaluate the risk factors identified in this review.

scholarly journals The risk of new-onset epilepsy and refractory epilepsy in older adult stroke survivors

Neurology ◽  
2019 ◽  
Vol 93 (6) ◽  
pp. e568-e577 ◽  
Author(s):  
Jorge G. Burneo ◽  
Tresah C. Antaya ◽  
Britney N. Allen ◽  
Andrea Belisle ◽  
Salimah Z. Shariff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adult ◽  
Refractory Epilepsy ◽  
Multivariable Analysis ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Risk Of Death ◽  
Younger Age ◽  
Epilepsy Diagnosis ◽  
New Onset

ObjectiveOur study objectives were to identify factors associated with new-onset epilepsy and refractory epilepsy among older adult stroke survivors and to evaluate the receipt of diagnostic care and mortality for participants who developed epilepsy.MethodsWe conducted a population-based, retrospective cohort study using linked, administrative health care databases. The Ontario Stroke Registry was used to identify patients 67 years and older who were hospitalized for a stroke at a designated stroke center in Ontario, Canada, between April 1, 2003, and March 31, 2009, and were previously free of epilepsy. Multivariable Fine–Gray hazard models were used to examine risk factors of epilepsy and refractory epilepsy, accounting for the competing risk of death.ResultsAmong 19,138 older adults hospitalized for a stroke, 210 (1.1%) developed epilepsy and 27 (12.9%) became refractory to antiepileptic drugs. Within 1 year of epilepsy diagnosis, 24 (11.4%) patients were assessed with EEG and 19 (9.0%) with MRI. In multivariable analysis, younger age and thrombolysis receipt significantly increased epilepsy risk. Lesser stroke severity and anticoagulant medication receipt also significantly increased epilepsy risk; however, these effects decreased over time. Younger age and female sex were the only risk factors of refractory epilepsy. In the 5 years following epilepsy diagnosis, 97 (46.2%) participants died of any cause.ConclusionsOlder adult stroke survivors are less likely to develop epilepsy and pharmacologically refractory epilepsy. An estimated 86.6% of deaths among older adult stroke survivors with new-onset epilepsy are attributed to causes other than stroke or epilepsy.

scholarly journals P.009 Characterizing drug-resistant epilepsy in an adult cohort with new-onset epilepsy

2019 ◽  
Vol 46 (s1) ◽  
pp. S16
Author(s):  
A Denton ◽  
L Hernandez-Ronquillo ◽  
J Tellez-Zenteno ◽  
K Waterhouse
Keyword(s):  
Risk Factors ◽  
Age Of Onset ◽  
Significant Risk ◽  
Bivariate Analysis ◽  
Drug Resistant ◽  
Seizure Onset ◽  
Cranial Trauma ◽  
Drug Resistant Epilepsy ◽  
New Onset

Background: There are few studies exploring rates of drug resistant epilepsy in populations with new-onset epilepsy (NOE). This prospective cohort study characterizes the development of drug-resistant epilepsy (DRE) and risk factors in an adult cohort with NOE or newly-diagnosed epilepsy (NDE). Methods: Patients are from the Single Seizure Clinic (SSC) in Saskatoon, SK between 2011 and 2018. The SSC sees patients who experience their first seizure; approximately 30% are diagnosed with epilepsy. Patients were followed prospectively. We identified the following variables in the cohort: epilepsy type, seizure onset, etiology, syndromes, and rates of DRE. Inclusion criteria included patients with NO and NDE, at least 18 years at diagnosis, and a minimum 1 year of follow-up. Results: Ninety-five patients were included, 46 females and 49 males. Median age of onset was 33 years. Of those, 28.4% developed DRE. Average time between onset and DRE diagnosis was 1.44 years. Bivariate analysis identified age, gender, and cranial trauma as significant risk factors for DRE. The multivariate model was not significant. Conclusions: Our study shows that patients with new-onset epilepsy have are less likely to develop DRE compared with patients from epilepsy clinics. This study contributes valuable information about NO epilepsy in adults and the development of DRE.

scholarly journals Postcranioplasty seizures following decompressive craniectomy and seizure prophylaxis: a retrospective analysis at a single institution

2019 ◽  
Vol 131 (3) ◽  
pp. 936-940 ◽  
Author(s):  
Mun-Chun Yeap ◽  
Ching-Chang Chen ◽  
Zhuo-Hao Liu ◽  
Po-Chuan Hsieh ◽  
Cheng-Chi Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Multivariable Analysis ◽  
Seizure Prophylaxis ◽  
High Incidence ◽  
Prophylactic Use ◽  
Early Seizures ◽  
New Onset

OBJECTIVECranioplasty is a relatively simple and less invasive intervention, but it is associated with a high incidence of postoperative seizures. The incidence of, and the risk factors for, such seizures and the effect of prophylactic antiepileptic drugs (AEDs) have not been well studied. The authors’ aim was to evaluate the risk factors that predispose patients to postcranioplasty seizures and to examine the role of seizure prophylaxis in cranioplasty.METHODSThe records of patients who had undergone cranioplasty at the authors’ medical center between 2009 and 2014 with at last 2 years of follow-up were retrospectively reviewed. Demographic and clinical characteristics, the occurrence of postoperative seizures, and postoperative complications were analyzed.RESULTSAmong the 583 patients eligible for inclusion in the study, 247 had preexisting seizures or used AEDs before the cranioplasty and 336 had no seizures prior to cranioplasty. Of these 336 patients, 89 (26.5%) had new-onset seizures following cranioplasty. Prophylactic AEDs were administered to 56 patients for 1 week after cranioplasty. No early seizures occurred in these patients, and this finding was statistically significant (p = 0.012). Liver cirrhosis, intraoperative blood loss, and shunt-dependent hydrocephalus were risk factors for postcranioplasty seizures in the multivariable analysis.CONCLUSIONSCranioplasty is associated with a high incidence of postoperative seizures. The prophylactic use of AEDs can reduce the occurrence of early seizures.

scholarly journals New-onset Atrial Fibrillation In Sepsis No Correlation With Inflammatory Cytokines in Real-life Clinical Setting

2020 ◽  
Author(s):  
Zhuanyun Li ◽  
Dandan Li ◽  
Yage Chai ◽  
Jiming Li ◽  
Peng Peng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Inflammatory Cytokines ◽  
Inflammatory Cytokine ◽  
Troponin T ◽  
Multivariable Analysis ◽  
Sepsis Group ◽  
Control Group ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background New-onset atrial fibrillation(new-onset AF) is one of the most common tachyarrhythmia in critically ill patients and is associated with increased morbidity and mortality. Unfortunately, risk factors for new-onset AF in sepsis have not been clearly elucidated. This study aims to determine the association of new-onset AF with circulating inflammatory cytokine concentrations. Methods This is a retrospective analysis of the relationship between new-onset AF in sepsis and inflammatory cytokine concentrations. The study included patients with sepsis diagnosed in the Emergency Intensive Care Unit(EICU) of The First Affiliated Hospital of Xinjiang Medical University. This study was conducted on data submitted from June 2016 through May 2019. The patients were classified based on the new-onset AF into Control group(n = 100)、Non New-onset AF in sepsis group(n = 182)、New-onset AF in sepsis group(n = 89). We aimed to investigate whether new-onset AF in sepsis can be explained by increased circulating inflammatory cytokine concentrations. Results Unadjusted analysis of the 371 observations from the retrospective cohort study demonstrated that serum cytokine concentrations do not correlate with new-onset AF in sepsis, despite the fact that cytokines predict mortality and correlate with organ dysfunction and sepsis severity (APACHEⅡ and SOFA scores). On multivariable analysis, the present study shows that hypertension, BMI, fibrinogen and hs-Troponin-T strongly correlated with the new-onset AF in sepsis. Besides, none of the cytokine concentrations correlated with any of the hs-Troponin-T or fibrinogen. Conclusions Our study shows that risk factors for new-onset AF in sepsis are mainly factors that are associated with the pre-admission comorbidity, coagulation, cardiac biomarkers. none of the measured inflammatory cytokines correlates with new-onset AF in sepsis.

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