Epilepsziasebészeti beavatkozások eredményei a Pécsi                     Epilepszia Centrumban 2005 és 2016 között

Abstract: Introduction: Epilepsy as a chronic, severe neurologic disease significantly influences the quality of life of the epileptic patients. In candidates well selected for surgery, the seizure freedom is realistically achievable, and the quality of life can be further improved with complex individual rehabilitation. Aim: We aimed to evaluate the postoperative outcome of patients who underwent epilepsy surgery between 2005 and 2016 at the Epilepsy Center at Pécs. Method: We evaluated seizure status at regular follow-up visits after surgery and the quality of life using questionnaires focusing on employment and social status. Results: 76% of the 72 patients who underwent surgical resection for epilepsy were free from disabling seizures , and 10% had rare disabling seizures (almost seizure-free), 7% experienced worthwhile improvement and 7% had no worthwhile improvement. Comparing the employment status of patients free from disabling seizures to patients not free from disabling seizures, we found that the employment status is significantly influenced by seizure freedom (p<0.01, Fisher’s exact test). While 67% of seizure-free patients were employed, only 19% of patients not free from disabling seizures were hired. Conclusion: Our results resemble the international tendencies and success rate, proving epilepsy surgery as an available, valid and effective treatment in well selected patients. Orv Hetil. 2019; 160(7): 270–278.

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Safety, efficacy, and life satisfaction following epilepsy surgery in patients aged 60 years and older

Journal of Neurosurgery ◽

10.3171/2015.3.jns142317 ◽

2016 ◽

Vol 124 (4) ◽

pp. 945-951 ◽

Cited By ~ 16

Author(s):

Sandra Dewar ◽

Dawn Eliashiv ◽

Patricia D. Walshaw ◽

Jerome Engel ◽

Itzhak Fried ◽

...

Keyword(s):

Quality Of Life ◽

Life Satisfaction ◽

Epilepsy Surgery ◽

Study Data ◽

Seizure Freedom ◽

Medical Comorbidity ◽

Maximum Score ◽

The Mean

OBJECT Despite its potential to offer seizure freedom, resective epilepsy surgery (RES) is seldom performed in patients 60 years of age or older. Demonstrating successful outcomes including an improved quality of life may raise awareness about the advantages of referring this underrepresented population for specialized evaluation. Accordingly, the authors investigated outcomes and life fulfillment in patients with an age ≥ 60 years who had undergone RES. METHODS All patients who, at the age of 60 years or older, had undergone RES for medically refractory focal onset seizures at the authors’ center were evaluated. A modified Liverpool Life Fulfillment (LLF) tool was administered postoperatively (maximum score 32). Seizure outcomes were classified according to the Engel classification system. RESULTS Twelve patients underwent RES. The majority of patients (9 [75%] of 12) had at least 1 medical comorbidity in addition to seizures. The mean follow-up was 3.1 ± 2.1 years. At the time of the final follow-up, 11 (91.7%) of 12 patients were documented as having a good postsurgical outcome (Engel Class I-II). Half (6 of 12 patients) were completely seizure free (Engel Class IA). Liverpool Life Fulfillment (LLF) data were available for 11 patients. Following surgery, the mean LLF score was 26.7 ± 6. Eight patients (72.7%) noted excellent satisfaction with their RES, with 5 (45.5%) noting postoperative improvements in overall health. CONCLUSIONS Resective epilepsy surgery is safe and effective in patients with an age ≥ 60 years. Over 90% had a good surgical outcome, with 50% becoming completely seizure free despite 1 or more medical comorbidities in the majority. The study data indicated that an advancing age should not negatively influence consideration for RES.

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Resective epilepsy surgery in tuberous sclerosis complex: a nationwide multicentre retrospective study from China

Brain ◽

10.1093/brain/awz411 ◽

2020 ◽

Vol 143 (2) ◽

pp. 570-581 ◽

Cited By ~ 5

Author(s):

Shiyong Liu ◽

Tao Yu ◽

Yuguang Guan ◽

Kai Zhang ◽

Ping Ding ◽

...

Keyword(s):

Quality Of Life ◽

Tuberous Sclerosis ◽

Epilepsy Surgery ◽

Tuberous Sclerosis Complex ◽

Intelligence Quotient ◽

Influence Factors ◽

Seizure Freedom ◽

Postoperative Seizure

Abstract At least 50% of patients with tuberous sclerosis complex present with intractable epilepsy; for these patients, resective surgery is a treatment option. Here, we report a nationwide multicentre retrospective study and analyse the long-term seizure and neuropsychological outcomes of epilepsy surgery in patients with tuberous sclerosis complex. There were 364 patients who underwent epilepsy surgery in the study. Patients’ clinical data, postoperative seizure outcomes at 1-, 4-, and 10-year follow-ups, preoperative and postoperative intelligence quotients, and quality of life at 1-year follow-up were collected. The patients’ ages at surgery were 10.35 ± 7.70 years (range: 0.5–47). The percentage of postoperative seizure freedom was 71% (258/364) at 1-year, 60% (118/196) at 4-year, and 51% (36/71) at 10-year follow-up. Influence factors of postoperative seizure freedom were the total removal of epileptogenic tubers and the presence of outstanding tuber on MRI at 1- and 4-year follow-ups. Furthermore, monthly seizure (versus daily seizure) was also a positive influence factor for postoperative seizure freedom at 1-year follow-up. The presence of an outstanding tuber on MRI was the only factor influencing seizure freedom at 10-year follow-up. Postoperative quality of life and intelligence quotient improvements were found in 43% (112/262) and 28% (67/242) of patients, respectively. Influence factors of postoperative quality of life and intelligence quotient improvement were postoperative seizure freedom and preoperative low intelligence quotient. The percentage of seizure freedom in the tuberectomy group was significantly lower compared to the tuberectomy plus and lobectomy groups at 1- and 4-year follow-ups. In conclusion, this study, the largest nationwide multi-centre study on resective epilepsy surgery, resulted in improved seizure outcomes and quality of life and intelligence quotient improvements in patients with tuberous sclerosis complex. Seizure freedom was often achieved in patients with an outstanding tuber on MRI, total removal of epileptogenic tubers, and tuberectomy plus. Quality of life and intelligence quotient improvements were frequently observed in patients with postoperative seizure freedom and preoperative low intelligence quotient.

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Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome

European Journal of Medical Research ◽

10.1186/s40001-021-00484-z ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Peter Tschann ◽

Nikola Vitlarov ◽

Martin Hufschmidt ◽

Daniel Lechner ◽

Paolo N. C. Girotti ◽

...

Keyword(s):

Quality Of Life ◽

Colorectal Resection ◽

Postoperative Outcome ◽

Resection Margins ◽

Pain Level ◽

Histopathological Findings ◽

Vas Score ◽

Reduction Of Pain

Abstract Introduction Endometriosis is associated with a high number of chronic pelvic pain and reduced quality of life. Colorectal resections in case of bowel involvement of endometriosis are associated with an unneglectable morbidity in young and healthy patients. There is no linear correlation established between the degree of symptoms and stage of endometriosis. The aim of this study was to correlate the histological findings to preoperative pain scores in colorectal resected patients with endometriosis. Methods Twenty-five patients who underwent laparoscopic colorectal resection for endometriosis between 2014 and 2019 were included in this retrospective study. Pain level was assessed preoperatively and postoperatively via phone call in May 2020. Histopathology was correlated to preoperative symptoms and postoperative outcome. Results Average follow-up time was 38.68 months (± 19.92). Preoperative VAS-score was 8.32 (± 1.70). We observed a significant reduction of pain level in all patients after surgery (p ≤ 0.005). Pain levels were equal regarding the presence of satellite spots and various degrees of infiltration depth. The resection margins were clear in all patients. Postoperative complications occurred in 6 cases (24%) and anastomotic leakage was observed in 3 patients (12%). Average VAS-score at time of follow-up was 1.70 (± 2.54). Conclusion Our data demonstrate that adequate colorectal resection leads to reduction of pain and an increase of quality of life irrespective of histopathological findings. An experienced team is necessary to improve intraoperative outcome and to reduce postoperative morbidity in case of complication.

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Psychiatric and psychosocial morbidity 1 year after epilepsy surgery

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2020.114 ◽

2020 ◽

pp. 1-8

Author(s):

S. Patel ◽

M. Clancy ◽

H. Barry ◽

N. Quigley ◽

M. Clarke ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Epilepsy Surgery ◽

Refractory Epilepsy ◽

Post Surgery ◽

Axis I ◽

Patients With Epilepsy ◽

The Impact

Abstract Objectives: There is a high rate of psychiatric comorbidity in patients with epilepsy. However, the impact of surgical treatment of refractory epilepsy on psychopathology remains under investigation. We aimed to examine the impact of epilepsy surgery on psychopathology and quality of life at 1-year post-surgery in a population of patients with epilepsy refractory to medication. Methods: This study initially assessed 48 patients with refractory epilepsy using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life in Epilepsy Inventory 89 (QOLIE-89) on admission to an Epilepsy Monitoring Unit (EMU) as part of their pre-surgical assessment. These patients were again assessed using the SCID-I, QOLIE-89 and HADS at 1-year follow-up post-surgery. Results: There was a significant reduction in psychopathology, particularly psychosis, following surgery at 1-year follow-up (p < 0.021). There were no new cases of de novo psychosis and surgery was also associated with a significant improvement in the quality of life scores (p < 0.001). Conclusions: This study demonstrates the impact of epilepsy surgery on psychopathology and quality of life in a patient population with refractory surgery. The presence of a psychiatric illness should not be a barrier to access surgical treatment.

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Neuropsychological outcome after epilepsy surgery in patients with bilateral Ammon's horn sclerosis

Journal of Neurosurgery ◽

10.3171/2014.7.jns132037 ◽

2014 ◽

Vol 121 (5) ◽

pp. 1247-1256 ◽

Cited By ~ 10

Author(s):

Viola L. Vogt ◽

Juri-Alexander Witt ◽

Michael P. Malter ◽

Jan-Christoph Schoene-Bake ◽

Marec von Lehe ◽

...

Keyword(s):

Quality Of Life ◽

Epilepsy Surgery ◽

Verbal Memory ◽

Daily Living ◽

Subjective Outcome ◽

Subjective Memory ◽

Floor Effect ◽

Nonverbal Memory

Object The purpose of this study was to retrospectively assess the objective and subjective neuropsychological outcome after epilepsy surgery in patients with bilateral Ammon's horn sclerosis (AHS). Methods Memory and executive functions were evaluated at baseline and at follow-up in 11 surgically treated patients and compared with 8 pharmacologically treated patients with temporal lobe epilepsy and bilateral AHS. The median follow-up duration was 16 months in the surgically treated patients and 80.5 months in the pharmacologically treated group. Subjective outcome was evaluated by questionnaires and included mood, quality of life, subjective memory, and activities of daily living. Results At the follow-up assessment, 82% of the surgically treated patients as opposed to 0% of the nonsurgery patients were seizure free. In the surgical group, nonverbal memory performance did not change significantly in any patient after surgery, but there was a floor effect in 55% of the surgical patients. Regarding verbal memory, 9% of the surgical patients improved while 73% declined, despite severe impairments already evident at baseline. In the nonsurgery control group, 13% of the patients declined in nonverbal memory (floor effect in 63%) and 25% declined in verbal memory (floor effect in 25%) at follow-up. None of the controls improved at follow-up. Executive functions remained unchanged on an impaired level in both groups. At follow-up, the patient groups did not differ significantly with respect to mood, quality of life, subjective memory, or activities of daily living. However, in most aspects, surgically treated patients reported a slightly better subjective outcome than pharmacologically treated patients and a significantly improved quality of life. Conclusions These results suggest that beyond benefits concerning seizure control, surgically treated patients with bilateral AHS, despite already poor baseline performance, are still at risk for severe postoperative decline in memory. In the light of predominantly minor benefits on a subjective level, the findings put the overall outcome of epilepsy surgery in bilateral AHS patients into perspective.

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Predictors of quality of life after resective extratemporal epilepsy surgery in adults in long-term follow-up

Seizure ◽

10.1016/j.seizure.2009.04.010 ◽

2009 ◽

Vol 18 (7) ◽

pp. 498-503 ◽

Cited By ~ 22

Author(s):

Alaa Eldin Elsharkawy ◽

Theodor May ◽

Rupprecht Thorbecke ◽

Alois Ebner

Keyword(s):

Quality Of Life ◽

Epilepsy Surgery ◽

Long Term Follow Up

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Postoperative Evaluation of the Quality of Life, Depression, and Anxiety of Temporal Lobe Epilepsy Cohort: A Single Institute Experience in Indonesia

Frontiers in Neurology ◽

10.3389/fneur.2021.708064 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yuriz Bakhtiar ◽

Surya Pratama Brilliantika ◽

Jacob Bunyamin ◽

Muhammad Thohar Arifin ◽

Hardian Hardian ◽

...

Keyword(s):

Quality Of Life ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Service Providers ◽

Limited Resource ◽

Anxiety And Depression ◽

Seizure Freedom ◽

Depression And Anxiety

Background: Besides seizure control, quality of life (QoL) should be considered as an equally important outcome for epilepsy surgery service providers. The paucity of QoL reports from developing countries has enlarged the representation gap between wealthy countries and countries with fewer resources. In this study, we evaluated postoperative QoL in the Indonesian drug-resistant epilepsy cohort where the epilepsy surgery service faces limited resource availability.Methods: We evaluated the QoL in patients with temporal lobe epilepsy who underwent surgery in our epilepsy surgery center in Semarang, Indonesia, from 2001 until 2015. The follow–up period started in 2018 through 2019. Postoperative QoL, depression, and anxiety were evaluated with self-reporting questionnaires including the Quality of Life in Epilepsy Inventory-31, Beck Depression Inventory-II, and Zung Self-Rating Anxiety Scales.Results: Forty returned questionnaires were included in the analysis (male 25, 62.5%; mean age 27.6 ± 9.05 years). The seizure-free cohort (n = 22, 55.0%) reported higher scores in most QoL dimensions particularly adjustment, overall QoL, and seizure worry compared to those with persistent seizures. The overall QoL level was correlated with seizure freedom and surgery type. QoL dimensions were negatively correlated with anxiety and depression levels.Conclusions: Postoperative seizure freedom was a major factor of postoperative QoL level. Besides seizure freedom, anxiety and depression levels were also negatively correlated with QoL levels in the Indonesian population.

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Seizure freedom improves health‐related quality of life after epilepsy surgery in children

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.14390 ◽

2019 ◽

Vol 62 (5) ◽

pp. 600-608 ◽

Cited By ~ 6

Author(s):

Puneet Jain ◽

Mary Lou Smith ◽

Kathy Speechley ◽

Mark Ferro ◽

Mary Connolly ◽

...

Keyword(s):

Quality Of Life ◽

Epilepsy Surgery ◽

Seizure Freedom ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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Outcome of lesional epilepsy surgery

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000627 ◽

2019 ◽

Vol 9 (4) ◽

pp. 286-295 ◽

Cited By ~ 1

Author(s):

Jafar Mehvari Habibabadi ◽

Houshang Moein ◽

Reza Basiratnia ◽

Shervin Badihian ◽

Bagher Zaki ◽

...

Keyword(s):

Epilepsy Surgery ◽

Focal Epilepsy ◽

Postoperative Outcome ◽

Resource Poor Setting ◽

Seizure Freedom ◽

Mesial Temporal Sclerosis ◽

Prospective Longitudinal Study ◽

Mortality And Morbidity ◽

Prospective Longitudinal

BackgroundWe investigated the utility of epilepsy surgery and postoperative outcome in patients with lesional epilepsy in Iran, a relatively resource-poor setting.MethodsThis prospective longitudinal study was conducted during 2007–2017 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with a diagnosis of intractable focal epilepsy, with MRI lesions, who underwent epilepsy surgery and were followed up ≥ 24 months, were included and evaluated for postoperative outcome.ResultsA total of 214 patients, with a mean age of 26.90 ± 9.82 years (59.8% men) were studied. Complex partial seizure was the most common type of seizure (85.9%), and 54.2% of the cases had auras. Temporal lobe lesions (75.2%) and mesial temporal sclerosis (48.1%) were the most frequent etiologies. With a mean follow-up of 62.17 ± 19.33 months, 81.8% of patients became seizure-free postoperatively. Anticonvulsants were reduced in 86% of the cases and discontinued in 40.7%. In keeping with previous studies, we found that seizure freedom rates were lower among patients with longer follow-up periods.ConclusionsWe found high rates of seizure freedom after surgery in lesional epilepsy patients despite limited facilities and infrastructure; antiepileptic medications were successfully tapered in almost half of the patients. Considering the favorable outcome of epilepsy surgery in our series, we believe that it is a major treatment option, even in less resource-intensive settings, and should be encouraged. Strategies to allow larger scale utility of epilepsy surgery in such settings in the developing world and dissemination of such knowledge may be considered an urgent clinical need, given the established mortality and morbidity in refractory epilepsy.

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