Clinical Outcomes and Quality of Life Following Surgical Treatment for Refractory Epilepsy

Abstract

Surgery for refractory epilepsy is widely used but the efficacy of this treatment for providing a seizure-free outcome and better quality of life remains unclear.This study aimed to update current evidence and to evaluate the effects of surgery on quality of life in patients with refractory epilepsy.A systematic review and meta-analysis of the literature were conducted and selected studies included 2 groups of refractory epilepsy patients, surgical and nonsurgical.The studies were assessed using the Newcastle–Ottawa Scale. The primary outcome was the seizure-free rate. The secondary outcome was quality of life. Adverse events were also reviewed.After screening, a total of 20 studies were selected: 8 were interventional, including 2 randomized controlled trials, and 12 were observational. All of the studies comprised 1959 patients with refractory epilepsy. The seizure-free rates were significantly higher for patients who received surgery compared with the patients who did not; the combined odds ratio was 19.35 (95% CI = 12.10–30.95, P < 0.001). After adjusting for publication bias the combined odds ratio was 10.25 (95% CI = 5.84–18.00). In both the interventional and observational studies, patients treated surgically had a significantly better quality of life compared with the patients not treated surgically. Complications were listed in 3 studies and the rates were similar in surgical and nonsurgical patients.Our meta-analysis found that for patients with refractory epilepsy, surgical treatment appears to provide a much greater likelihood of seizure-free outcome than nonsurgical treatment, although there is a need for more studies, particularly randomized studies, to confirm this conclusion. Based on more limited data, surgical treatment also appeared to provide a better quality of life and did not seem to increase complications.

Drug‐resistant parietal lobe epilepsy: clinical manifestations and surgery outcome

“…Moreover, many areas within the parietal lobe have critical functions (Kamali et al ., ; Kim et al ., ; Binder et al ., ). Based on previous studies, compared with temporal lobe epilepsy, success rates and seizure outcome for epilepsy surgery in drug‐resistant PLEs is less promising (Binder et al ., ; Harroud et al ., ; Liu et al ., ).…”

A prospective study contrasting the psychiatric outcome in drug‐resistant epilepsy between patients who underwent surgery and a control group

“…It is a well‐known fact that psychiatric morbidity in epilepsy is high, with reported lifetime prevalence rates of up to 50% . This comorbidity influences quality of life (QoL), even independent of seizures …”

“…Patients with treatment‐refractory seizures are at a higher risk of developing psychiatric disorders . Surgery is proven to be the best therapeutic alternative for treating drug‐resistant epilepsy, leading to a seizure‐free outcome in about two thirds of patients and improving patients' QoL …”

Parametric subtracted post‐ictal diffusion tensor imaging for guiding direct neurostimulation therapy

“…Patients who suffer from medically refractory partial‐onset epilepsy account for ~30% of all epilepsies (Brodie & Dichter, ; Liu et al, ). Standard of care surgical treatment options for this condition include resective surgery, vagal nerve stimulation (VNS), or, more recently, deep brain stimulation therapy (DBS, Medtronic, Minneapolis, MN), and responsive neurostimulation therapy (RNS, NeuroPace, Mountain View, CA) (Morrell, ).…”