Epilepsy surgery: Late seizure recurrence after initial complete seizure freedom

Petrik, Stephan; Antonio‐Arce, Victoria San; Steinhoff, Bernhard J.; Syrbe, Steffen; Bast, Thomas; Scheiwe, Christian; Brandt, Armin; Beck, Juergen; Schulze‐Bonhage, Andreas

doi:10.1111/epi.16893

Cited by 13 publications

(26 citation statements)

References 44 publications

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“…Early studies by Rasmussen 18 described long‐term surgical outcome, noting 13% of "nontumoral" (median follow‐up = 12 years) and 6% of "tumoral" cases (median follow‐up = 8 years) experienced occasional seizures after at least 3 years free of seizures postsurgery. Late recurrences between 5 and 10 years postsurgery have been described in more recent cohorts 2,5,6,14,17,19,20 . There are few detailed data available relevant to the period after 10 postoperative years, although first recurrences after this time have been noted 2,14,21,22 .…”

Section: Discussionmentioning

confidence: 99%

“…Studies have demonstrated that most individuals who undergo resection of their seizure focus attain seizure freedom or significant reduction in seizures after surgery 1 . Unfortunately, for some individuals, the seizure freedom experienced in the first few years after surgery may not be maintained, with late seizure recurrence reported in a number of studies 2–6 . This outcome is potentially devasting, as many individuals have made a new life 7 and may believe surgery has cured their epilepsy.…”

Section: Introductionmentioning

confidence: 99%

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Extended follow‐up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery

2022

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Objective: Anterior temporal lobectomy (ATL) for medication-resistant localized epilepsy results in ablation or reduction of seizures for most patients. However, some individuals who attain an initial extended period of postsurgical seizure freedom will experience a later seizure recurrence. In this study, we examined the prevalence and some risk factors for late recurrence in an ATL cohort with extensive regular follow-up.Methods: Included were 449 patients who underwent ATL at Austin Health, Australia, from 1978 to 2008. Postsurgical follow-up was undertaken 2-3 yearly.Seizure recurrence was tested using Kaplan-Meier analysis, log-rank test, and Cox regression. Late recurrence was qualified as a first disabling seizure >2 years postsurgery. We examined risks within the ATL cohort according to broad pathology groups and tested whether late recurrence differed for the ATL cohort compared to patients who had resections outside the temporal lobe (n = 98).Results: Median post-ATL follow-up was 22 years (range = .1-38.6), 6% were lost to follow-up, and 12% had died. Probabilities for remaining completely seizurefree after surgery were 51% (95% confidence interval [CI] = 53-63) at 2 postoperative years, 36% (95% CI = 32-41) at 10 years, 32% (95% CI = 27-36) at 20 years, and 30% (95% CI = 25-34) at 25 years. Recurrences were reported up to 23 years postoperatively. Late seizures occurred in all major ATL pathology groups, with increased risk in the "normal" and "distant lesion" groups (p ≤ .03). Comparison between the ATL cohort and patients who underwent extratemporal resection demonstrated similar patterns of late recurrence (p = .74).Significance: Some first recurrences were very late, reported decades after ATL. Late recurrences were not unique to any broad ATL pathology group and did not differ according to whether resections were ATL or extratemporal. Reports of these events by patients with residual pathology suggest that potentially epileptogenic abnormalities outside the area of resection may be implicated as one of several possible underlying mechanisms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Extended follow‐up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery

2022

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“…Bartolomei et al 21 observed, when comparing different subtypes of TLE (including TS epilepsies), a relationship between the duration of epilepsy and the extent of the epileptogenicity, thus suggesting a progressive recruitment of epileptogenic structures in human brain. Conversely, in a series including mainly lesional patients, 22 late recurrences were explained by the presence of epileptogenic networks not detected preoperatively as well by the incomplete resection of the epileptogenic lesion. In a recent study 23 combining clinical variables with brain connectome-derived features to predict seizure outcome, long-term seizure relapse was not specifically related to parameters predicting short-term outcome, thus suggesting different mechanisms In our analysis of associations, we found that undergoing TPE surgery was associated with better seizure outcome in both the short and long term in temporal plus patients.…”

Section: T a B L E 1 Univariate And Multivariate Population Average L...mentioning

confidence: 77%

Surgical outcome of temporal plus epilepsy is improved by multilobar resection

et al. 2022

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“…Although we report a fairly robust mean follow-up duration of 3.6 years across the included literature, seizure recurrence can occur 5 years or more after surgery. 61 Furthermore, although concomitant FCD seems to reduce the efficacy of ECoG-guided resection, only a single study in the meta-analysis group examined this patient population. Given this, further study of these most challenging cases of MRE should be performed.…”

Section: Discussionmentioning

confidence: 99%

Electrocorticography-Guided Resection Enhances Postoperative Seizure Freedom in Low-Grade Tumor-Associated Epilepsy: A Systematic Review and Meta-Analysis

et al. 2022

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BACKGROUND: Low-grade cerebral neoplasms are commonly associated with medically intractable epilepsy. Despite increasing evidence that epileptogenic brain regions commonly extend beyond visible tumor margins, the utility of extended surgical resections leveraging intraoperative electrocorticography (ECoG) remains unclear. OBJECTIVE: To determine whether ECoG-guided surgery is associated with improved postoperative seizure control. METHODS: We performed a systematic review and meta-analysis encompassing both adult and pediatric populations. The primary outcome measure was postoperative seizure freedom as defined by Engel class I outcome. Class I/II outcome served as a secondary measure. Relevant clinical and operative data were recorded. A random-effects metaanalysis based on the pooled odds ratio (OR) of seizure freedom was performed on studies that reported comparative data between ECoG-guided surgery and lesionectomy. RESULTS: A total of 31 studies encompassing 1115 patients with medically refractory epilepsy met inclusion criteria. Seven studies reported comparative data between ECoGguided surgery and lesionectomy for meta-analysis. Tumor resection guided by ECoG was associated with significantly greater postoperative seizure freedom (OR 3.95, 95% CI 2.32-6.72, P < .0001) and class I/II outcome (OR 5.10, 95% CI 1.97-13.18, P = .0008) compared with lesionectomy. Postoperative adverse events were rare in both groups. CONCLUSION: These findings provide support for the utilization of ECoG-guided surgery to improve postoperative seizure freedom in cases of refractory epilepsy associated with low-grade neoplasms. However, this effect may be attenuated in the presence of concomitant cortical dysplasia, highlighting a need for improved presurgical and intraoperative monitoring for these most challenging cases of localization-related epilepsy.

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Epilepsy surgery: Late seizure recurrence after initial complete seizure freedom

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 13 publications

References 44 publications

Extended follow‐up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery

Extended follow‐up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery

Surgical outcome of temporal plus epilepsy is improved by multilobar resection

Electrocorticography-Guided Resection Enhances Postoperative Seizure Freedom in Low-Grade Tumor-Associated Epilepsy: A Systematic Review and Meta-Analysis

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