Long-term Seizure Outcome in Reoperation after Failure of Epilepsy Surgery

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. 873-880 ◽  
Author(s):  
Jorge A. González-Martínez ◽  
Teeradej Srikijvilaikul ◽  
Dileep Nair ◽  
William E. Bingaman
Keyword(s):  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
Cortical Dysplasia ◽  
Categorical Variables ◽  
Seizure Outcome ◽  
Mesial Temporal Sclerosis ◽  
Long Term Outcome ◽  
The Relationship

Abstract OBJECTIVE Treatment of patients who fail epilepsy surgery is problematic. Selected patients may be candidates for further surgery, potentially leading to a significant decrease in the frequency and severity of seizures. We present our long-term outcome series of highly investigated patients who failed resective epilepsy surgery and subsequently underwent reoperative resective procedures. METHODS We performed a retrospective consecutive analysis of patients who underwent reoperative procedures because of medically intractable epilepsy at our institution from 1990 to 2001. Seventy patients underwent reoperative epilepsy surgery, with 57 patients having a minimum follow-up period of 2 years. We assessed the relationship between seizure outcome and categorical variables using χ2 and Fisher's exact tests, and the relationship between outcome and continuous variables using a Wilcoxon rank-sum test. Statistical significance was set at a P value of 0.05. RESULTS Of the 57 patients (29 male and 28 female patients), the age of seizure onset ranged from 3 months to 39 years (mean, 10.7 ± 10.3 yr; median, 7 yr). The mean age at reoperation was 24.7 ± 12 years (range, 4–50 yr). The interval between first and second resection was 7 days to 16 years. The follow-up period ranged from 24 to 228 months (mean, 128 mo; mode, 132 mo). Seizure outcome was classified according to Engel's classification. Fifty-two percent of the patients had a favorable outcome (38.6% were Class I and 14.0% were Class II). Patients with tumors as their initial pathology had better outcome compared with patients with focal cortical dysplasia and mesial temporal sclerosis (P < 0.05). CONCLUSION Reoperation should be considered in selected patients failing epilepsy resective surgery because approximately 50% of patients may have benefit. Patients with cortical dysplasia and mesial temporal sclerosis are less likely to improve after reoperation.

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.

LONG-TERM SEIZURES AND QUALITY OF LIFE AFTER EPILEPSY SURGERY COMPARED WITH MATCHED CONTROLS

Neurosurgery ◽  
2008 ◽  
Vol 62 (2) ◽  
pp. 326-335 ◽  
Author(s):  
Knut Stavem ◽  
Helge Bjørnæs ◽  
Iver A. Langmoen
Keyword(s):  
Quality Of Life ◽  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
Two Dimensions ◽  
Three Dimensions ◽  
Seizure Type ◽  
Seizure Outcome

Abstract OBJECTIVE We compared long-term seizure outcome and health-related quality of life (HRQoL) of patients who underwent epilepsy surgery and matched medically treated nonsurgical controls with intractable epilepsy. METHODS Medically treated controls were identified for patients operated on for epilepsy between January 1, 1949 and December 31, 1992. We used a matched cohort design, matching for age, sex, and seizure type. The analysis was based on 70 complete matching pairs. HRQoL was assessed with the Quality of Life in Epilepsy Inventory 89 questionnaire an average of 15 years after surgery. RESULTS Among surgery patients, 48% were seizure-free during the previous year compared with 19% of the controls (P = 0.0004). Fewer surgery patients used antiepileptic drugs (70%) than controls (93%). The odds of being seizure-free were higher for surgery patients in total and in subgroups divided according to length of follow-up. The mean HRQoL for surgery patients was higher in five of the 17 Quality of Life in Epilepsy Inventory 89 dimensions and worse in none. Among patients with more than 7 years of follow-up, HRQoL was better in three dimensions and worse in none. Among patients with 7 years of follow-up or less, HRQoL was better in two dimensions and worse in the language dimension of the Quality of Life in Epilepsy Inventory 89. CONCLUSION After an average of more than 15 years of follow-up, epilepsy surgery patients had fewer seizures, used less antiepileptic medication, and had better HRQoL in several dimensions of the Quality of Life in Epilepsy Inventory 89 instrument than matched medically treated controls with refractory epilepsy, although possibly at a slight disadvantage in the language dimension among those with 7 years of follow-up or less.

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 Rasmussen Encephalitis: longterm outcome after surgery

2010 ◽  
Vol 16 (2) ◽  
pp. 59-63 ◽  
Author(s):  
Vera C. Terra ◽  
Helio R. Machado ◽  
Ricardo dos Santos Oliveira ◽  
Luciano N Serafini ◽  
Cecília Souza-Oliveira ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Language Impairment ◽  
Seizure Control ◽  
Demographic Data ◽  
Intractable Epilepsy ◽  
Seizure Outcome ◽  
Rasmussen Encephalitis ◽  
Eeg Abnormalities ◽  
Clonic Seizures

BACKGROUND AND PURPOSE: Rasmussen Encephalitis (RE) is characterized by intractable epilepsy, progressive hemiparesis and unilateral hemispheric atrophy. The progression of the symptoms usually occurs within months to few years. Antiepileptic drugs are usually not effective to control disease progression and epilepsy surgery in the form of hemispheric disconnection has been considered the treatment of choice. This work describes the clinical and electrographic analyses, as well as the post-operative evolution of patients with RE. PATIENTS AND METHODS: This work includes all the patients with RE evaluated from January 1995 to January 2008 by the Ribeirão Preto Epilepsy Surgery Program (CIREP) considering demographic data, interictal and ictal electroencephalographic (EEG) findings; anatomo-pathological findings and clinical outcome. RESULTS: Twenty-five patients were evaluated, thirteen were female. Mean age of epilepsy onset was 4.4±2.0 years. There were no differences between patients with slow and fast evolution with respect to age of epilepsy onset (p=0.79), age at surgery (p=0.24), duration of epilepsy (0.06), and follow-up (p=0.40). There were no correlations between the presence of bilateral EEG abnormalities or the absence of spikes and post-operative seizure outcome (p=0.06). Twenty-three patients underwent surgery. The mean follow-up was 75.3 months. Eleven patients had total seizure control. Twelve individuals persisted with seizures consisting of mild facial jerks (6 patients), occasional hemigeneralized tonic-clonic seizures (3 patients), and frequent tonic-clonic seizures (3 patients). Mental and language impairment was observed in 15 and 12 patients, after surgery, respectively. CONCLUSIONS: This retrospective study reported the clinical and electrographic analysis, as well as the evolution of 23 patients with RE. Fourteen patients achieved satisfactory seizure control, three patients had partial response to surgery, and five patients had maintenance of the pre-operative condition. All patients with left side involvement presented with some language and cognitive disturbance.

Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control

2013 ◽  
Vol 119 (2) ◽  
pp. 261-272 ◽  
Author(s):  
Robert E. Elliott ◽  
Robert J. Bollo ◽  
Jonathan L. Berliner ◽  
Alyson Silverberg ◽  
Chad Carlson ◽  
...  
Keyword(s):  
Statistical Power ◽  
Temporal Lobectomy ◽  
Binary Logistic Regression Analysis ◽  
Seizure Freedom ◽  
Mesial Temporal Sclerosis ◽  
Anterior Temporal Lobectomy ◽  
Long Term Outcome ◽  
The Impact

Object In this paper the authors' goal was to identify preoperative variables that predict long-term seizure freedom among patients with mesial temporal sclerosis (MTS) after single-stage anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH). Methods The authors retrospectively reviewed 116 consecutive patients (66 females, mean age at surgery 40.7 years) with refractory seizures and pathologically confirmed MTS who underwent ATL-AH with at least 2 years of follow-up. All patients underwent preoperative MRI and video-electroencephalography (EEG); 106 patients (91.4%) underwent Wada testing and 107 patients (92.2%) had neuropsychological evaluations. The authors assessed the concordance of these 4 studies (defined as test consistent with the side of eventual surgery) and analyzed the impact of preoperative variables on seizure freedom. Results The median follow-up after surgery was 6.7 years (mean 6.9 years). Overall, 103 patients (89%) were seizure free, and 109 patients (94%) had Engel Class I or II outcome. Concordant findings were highest for video-EEG (100%), PET (100%), MRI (99.0%), and Wada testing (90.4%) and lowest for SPECT (84.6%) and neuropsychological testing (82.5%). Using binary logistic regression analysis (seizure free or not) and Cox proportional hazard analysis (seizure-free survival), less disparity in the Wada memory scores between the ipsilateral and contralateral sides was associated with persistent seizures. Conclusions Seizure freedom of nearly 90% can be achieved with ATL-AH in properly selected patients with MTS and concordant preoperative studies. The low number of poor outcomes and exclusion of multistage patients limit the statistical power to determine preoperative variables that predict failure. Strong Wada memory lateralization was associated with excellent long-term outcome and adds important localization information to structural and neurophysiological data in predicting outcome after ATL-AH for MTS.

Long-term outcome of extratemporal resection in posttraumatic epilepsy

2012 ◽  
Vol 32 (3) ◽  
pp. E10 ◽  
Author(s):  
Shahin Hakimian ◽  
Amir Kershenovich ◽  
John W. Miller ◽  
Jeffrey G. Ojemann ◽  
Adam O. Hebb ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Term Outcome ◽  
Intracranial Eeg ◽  
Long Term Outcome ◽  
Posttraumatic Epilepsy ◽  
Factors Associated

Object Posttraumatic epilepsy (PTE) is a common cause of medically intractable epilepsy. While much of PTE is extratemporal, little is known about factors associated with good outcomes in extratemporal resections in medically intractable PTE. The authors investigated and characterized the long-term outcome and patient factors associated with outcome in this population. Methods A single-institution retrospective query of all epilepsy surgeries at Regional Epilepsy Center at the University of Washington was performed for a 17-year time span with search terms indicative of trauma or brain injury. The query was limited to adult patients who underwent an extratemporal resection (with or without temporal lobectomy), in whom no other cause of epilepsy could be identified, and for whom minimum 1-year follow-up data were available. Surgical outcomes (in terms of seizure reduction) and clinical data were analyzed and compared. Results Twenty-one patients met inclusion and exclusion criteria. In long-term follow-up 6 patients (28%) were seizure-free and an additional 6 (28%) had a good outcome of 2 or fewer seizures per year. Another 5 patients (24%) experienced a reduction in seizures, while only 4 (19%) did not attain significant benefit. The presence of focal encephalomalacia on imaging was associated with good or excellent outcomes in 83%. In 8 patients with the combination of encephalomalacia and invasive intracranial EEG, 5 (62.5%) were found to be seizure free. Normal MRI examinations preoperatively were associated with worse outcomes, particularly when combined with multifocal or poorly localized EEG findings. Two patients suffered complications but none were life threatening or disabling. Conclusions Many patients with extratemporal PTE can achieve good to excellent seizure control with epilepsy surgery. The risks of complications are acceptably low. Patients with focal encephalomalacia on MRI generally do well. Excellent outcomes can be achieved when extratemporal resection is guided by intracranial EEG electrodes defining the extent of resection.

scholarly journals Long-term outcomes of epilepsy surgery in 85 pediatric patients followed up for over 10 years: a retrospective survey

2017 ◽  
Vol 19 (5) ◽  
pp. 606-615 ◽  
Author(s):  
Hiroshi Hosoyama ◽  
Kazumi Matsuda ◽  
Tadahiro Mihara ◽  
Naotaka Usui ◽  
Koichi Baba ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Antiepileptic Drugs ◽  
Epilepsy Surgery ◽  
Social Engagement ◽  
Focal Cortical Dysplasia ◽  
Cortical Dysplasia ◽  
Seizure Outcome ◽  
Neoplastic Lesions ◽  
The Mean

OBJECTIVEThe aim of this study was to investigate the treatment outcomes and social engagement of patients who had undergone pediatric epilepsy surgery more than 10 years earlier.METHODSBetween 1983 and 2005, 110 patients younger than 16 years underwent epilepsy surgery at the National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders. The authors sent a questionnaire to 103 patients who had undergone follow-up for more than 10 years after surgery; 85 patients (82.5%) responded. The survey contained 4 categories: seizure outcome, use of antiepileptic drugs, social participation, and general satisfaction with the surgical treatment (resection of the epileptic focus, including 4 hemispherectomies). The mean patient age at the time of surgery was 9.8 ± 4.2 (SD) years, and the mean duration of postoperative follow-up was 15.4 ± 5.0 years. Of the 85 patients, 79 (92.9%) presented with a lesional pathology, such as medial temporal sclerosis, developmental/neoplastic lesions, focal cortical dysplasia, and gliosis in a single lobe.RESULTSFor 65 of the 85 responders (76.5%), the outcome was recorded as Engel Class I (including 15 [93.8%] of 16 patients with medial temporal sclerosis, 20 [80.0%] of 25 with developmental/neoplastic lesions, and 27 [73.0%] of 37 with focal cortical dysplasia). Of these, 29 (44.6%) were not taking antiepileptic drugs at the time of our survey, 29 (44.6%) held full-time jobs, and 33 of 59 patients (55.9%) eligible to drive had a driver's license. Among 73 patients who reported their degree of satisfaction, 58 (79.5%) were very satisfied with the treatment outcome.CONCLUSIONSThe seizure outcome in patients who underwent resective surgery in childhood and underwent followup for more than 10 years was good. Of 85 respondents, 65 (76.5%) were classified in Engel Class I. The degree of social engagement was relatively high, and the satisfaction level with the treatment outcome was also high. From the perspective of seizure control and social adaptation, resective surgery yielded longitudinal benefits in children with intractable epilepsy, especially those with a lesional pathology in a single lobe.

Glioneuronal tumors and medically intractable epilepsy: a clinical study with long-term follow-up of seizure outcome after surgery

2001 ◽  
Vol 43 (3) ◽  
pp. 179-191 ◽  
Author(s):  
Eleonora Aronica ◽  
Sieger Leenstra ◽  
Cees W.M van Veelen ◽  
Peter C van Rijen ◽  
Theo J Hulsebos ◽  
...  
Keyword(s):  
Clinical Study ◽  
Intractable Epilepsy ◽  
Seizure Outcome ◽  
Long Term Follow Up ◽  
Glioneuronal Tumors

scholarly journals Long‐term seizure outcome after epilepsy surgery in patients with mild malformation of cortical development and focal cortical dysplasia

2018 ◽  
Vol 4 (1) ◽  
pp. 170-175 ◽  
Author(s):  
Tim J. Veersema ◽  
Banu Swampillai ◽  
Cyrille H. Ferrier ◽  
Pieter Eijsden ◽  
Peter H. Gosselaar ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Focal Cortical Dysplasia ◽  
Cortical Development ◽  
Cortical Dysplasia ◽  
Seizure Outcome ◽  
Malformation Of Cortical Development

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.

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