Epilepsy duration and seizure outcome in epilepsy surgery

Abstract

ObjectiveTo conduct a systematic review and meta-analysis on the effect of earlier or later resective epilepsy surgery on seizure outcome.MethodsWe searched the electronic databases PubMed, EMBASE, and Cochrane Library for studies investigating the association of epilepsy duration and seizure freedom after resective surgery. Two reviewers independently screened citations for eligibility and assessed relevant studies for risk of bias. We combined data in meta-analyses using a random effects model. We assessed the certainty of evidence according to Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsTwenty-five studies were included, 12 of which had data suitable for meta-analyses. Comparing seizure outcome if epilepsy surgery was performed before vs after 2, 5, 10, and 20 years of epilepsy duration, and comparing epilepsy duration <5 years to >10 years, we found significant effects favoring shorter duration with risk differences ranging from 0.15 to 0.21 and risk ratios ranging from 1.20 to 1.33 (p < 0.01 for all comparisons). According to GRADE, we found low certainty of evidence favoring shorter epilepsy duration before surgery.ConclusionPeople with shorter epilepsy duration are more likely to be seizure-free at follow-up. Furthermore, there is a positive association between shorter duration and seizure freedom also for very long epilepsy durations. Patients who might benefit from epilepsy surgery should therefore be referred for presurgical assessments without further delay, regardless of epilepsy duration. The low certainty of evidence acknowledges concerns regarding study heterogeneity and possible residual confounding.

Temporal lobe epilepsy surgery in children and adults: A multicenter study

“…Conversely, duration of epilepsy did not predict seizure outcome. Shorter duration of epilepsy has been associated with better outcomes in some studies 7,9,36,37 but not in others, 13,18 possibly due to different designs (longitudinal or cross‐sectional) and statistical methods. Our findings, although confirming that there is a long delay before epilepsy surgery is performed, 4,24 indicate that patients with TLE who undergo surgery in childhood are more likely to achieve sustained seizure freedom.…”

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“…Other treatment options, such as surgery, are widely considered a last resort. Sadly, the associated time delay means such treatments may be less effective 78. The result is often years of reduced quality of life, lost productivity, and increased mortality 9…”

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“…Early referral of patients with drug-resistant epilepsy or with complex epilepsy syndromes (e.g., epileptic spasms [West syndrome], Dravet syndrome, continuous spikes and waves during slow sleep, tuberous sclerosis complex) is paramount to improve patients' chances to achieve seizure control and avoid impairment of neurological and cognitive development in children, irreversible psychological and social problems, [51,52] Carbamazepine Phenytoin life-long disability and premature death [57,58]. A recent systematic review showed that a shorter duration of epilepsy was significantly associated with a better seizure outcome after resective epilepsy surgery [59]. Aside from surgery, epilepsy centers can offer specialized diagnostic and therapeutic approaches that may identify the underlying cause of apparent or real drug resistance (e.g., non-adherence to medication, misdiagnosis, inadequate dosing, life style factors) and lead to seizure freedom in patients initially considered drug resistant (Fig.…”