Long term follow-up of the first 70 operated adults in the Goteborg Epilepsy Surgery Series with respect to seizures, psychosocial outcome and use of antiepileptic drugs

Asztély, Fredrik; Ekstedt, Gerd; Rydenhag, Bertil; Malmgren, Kristina

doi:10.1136/jnnp.2006.098244

Cited by 54 publications

(56 citation statements)

References 34 publications

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“…Successful epilepsy surgery can significantly improve the quality of life of epilepsy patients. Systematic reviews reported that 66%-70% of patients were seizure-free at short-term (,5 y) follow-up (1-4), and 41%-79% were seizurefree at long-term (.5 y) follow-up after temporal lobe resection (5)(6)(7)(8). Successful surgery depends on the accurate localization of epileptogenic focus.…”

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Clinical Value of the First Dedicated, Commercially Available Automatic Injector for Ictal Brain SPECT in Presurgical Evaluation of Pediatric Epilepsy: Comparison with Manual Injection

et al. 2013

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The most challenging technical problem in ictal brain SPECT for localization of an epileptogenic focus is obtaining a timely injection of a radiopharmaceutical. In our institution, the first dedicated commercially available, remotely controlled automatic injector has been used in the pediatric epilepsy unit in conjunction with 24-h video and electroencephalogram monitoring. The goal of this study was to demonstrate the improved success rate of ictal injection by use of the automatic injector in the pediatric population. Methods: Eighty-four pediatric patients and eighty-four 99m Tc-ethylcysteinate dimer ( 99m Tc-ECD) ictal brain SPECT studies were retrospectively analyzed in a masked manner. The group with manual injection consisted of 45 studies performed from 2004 to 2010 before the introduction of the automatic injector. The group with automatic injection consisted of 39 studies performed from 2010 to 2011 after the introduction of the automatic injector. The 2 groups were comparable in the total duration of seizure, injected dose, and time from the injection to the image acquisition. The latency time from the seizure onset to the initiation time of injection, the ratio of latency time to total duration of seizure (L/T), the number of patients with repeated studies, the number of days of additional hospitalization for each study, and the localization rate for identifying a single focus in each study were compared between the groups. Results: The median latency time in the group with automatic injection (8 s) was significantly lower than that of the group with manual injection (18 s) (P , 0.05). Also there was a statistically significant decrease in the number of patients with repeated studies in the group with automatic injection (2/39 [5%]), compared with the group with manual injection (14/45 [31%]) (P , 0.05). The median number of days of additional hospitalization in the group with manual injection (range, 0-7) was statistically significantly different, compared with the group with automatic injection (range, 0-1) (P , 0.05). In the group with automatic injection, 31 of 39 scans demonstrated a single localizing focus, compared to 22 of 45 scans from the manual-injection group, a significant difference (P , 0.05). The radiation exposure rate to nursing staff during the periods with automatic injection was lower than during the periods with manual injection. Conclusion: The automatic injector combined with 24-h video and electroencephalogram monitoring demonstrated significant clinical value by decreasing latency time, the number of patients with repeated studies, and the number of days of additional hospitalization while increasing the number of studies with a single localizing focus.

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Clinical Value of the First Dedicated, Commercially Available Automatic Injector for Ictal Brain SPECT in Presurgical Evaluation of Pediatric Epilepsy: Comparison with Manual Injection

et al. 2013

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“…Es existieren jedoch keine ausreichenden Daten, auf deren Grundlage Langzeitauswirkungen des Absetzens einer antikonvulsiven Medikation nach epilepsiechirurgischen Eingriffen beurteilt werden könnten. Mehrere Studien belegen, dass der Anteil von Patienten ohne Medikation nach epilepsiechirurgischen Eingriffen höher ist als in Kontrollgruppen [2,4,12,16,46]. Der Anteil epilepsiechirurgisch "heilbarer" Patienten ist jedoch derzeit unklar.…”

Section: Antikonvulsive Therapie Im Langzeitverlauf Nach Epilepsiechiunclassified

“…Zu berücksichtigen ist, dass allgemeine ökono-mische Aspekte insbesondere in Langzeitbeurteilungen der Beschäftigungsrate einfließen und die Beurteilung mancher Aspekte des Operationeffektes gerade bei langzeitiger Betrachtung erschweren. Eine jüngst publizierte schwedische Studie [2] bestätigte, dass es nur wenigen Patienten durch einen operativen Eingriff gelingt, neu eine Arbeitsstelle zu finden; die Gesamtquote der beschäftigten Patienten sank nach Operation von 74% sogar auf 63% nach zwei Jahren und 55% nach 10 Jahren. Betrachtet man die Patienten separat in Abhängigkeit vom Anfallsoutcome, so behielten anfallsfreie Patienten jedoch meist ihre Arbeit oder wechselten von Teilzeit-auf Vollzeitbeschäftigung, während nicht anfallsfreie Patienten häufig ihren Arbeitsplatz verloren.…”

Section: Psychosoziales Und Neuropsychologisches Outcomeunclassified

“…Kaplan-Meier-Kurven spiegeln diese divergenten Prozesse von -oft transienten -Rezidiven und Phänomenen wie dem postoperativen Running-down der Epilepsie [3,35] nicht adä-quat wider. In Gruppenstatistiken, die als Zielgröße eine Anfallsfreiheit über einen definierten Zeitraum von einem bis zwei Jahren vor der jeweiligen Evaluation wählen, bleiben die Raten anfallsfreier Patienten nach einer Beobachtungszeit von zwei Jahren meist konstant, wie bereits früher postuliert [25,34,36]; einzelne Studien weisen sogar eine höhere Quote terminaler Anfallsfreiheit im Langzeit-Follow-up als nach zwei Jahren auf ( [2], vgl. Abb.…”

Section: Schlussfolgerungenunclassified

“…2). Während eine Reihe von Analysen belegen, dass individuell Patienten im Verlauf aus der anfallsfreien Gruppe herausfallen als auch neu in diese hineinkommen können, verweisen neuere Studien von Mihara et al [30], Cohen-Gadol et al [7], Chan et al [6] und von Aszetly et al [2] auf eine auch individuell hohe Chance von ca. 90%, bei Anfallsfreiheit nach einem bzw.…”

Section: Schlussfolgerungenunclassified

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Langzeit-Outcome nach epilepsiechirurgischen Eingriffen

Schulze‐Bonhage

2008

Z. Epileptol.

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Identifying the trajectory of social milestones 15‐20 years after epilepsy surgery: Realistic timelines for postsurgical expectations

2019

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Objective Patients often undertake epilepsy surgery with the expectation that it will lead to improvements in their social situation. Short‐ to medium‐term research consistently points toward improvements in social outcomes; however, no study has mapped out postsurgical social timelines, particularly for longer‐term (>15 years) outcomes. Methods We recruited 39 patients who had undergone anterior temporal lobectomy (ATL) for drug‐resistant temporal lobe epilepsy (TLE) between 1994 and 2002. The cohort (24 females) had a median age of 49 years (range 38‐67), age of habitual seizure onset was 9.5 years (range 0.5‐29 years), and age at surgery was 31 years (range 20‐53). Patients were followed up for a median of 18.4 years postsurgery (IQR = 4.4). Using data obtained from semistructured interviews, we conducted a comprehensive qualitative analysis of patients' self‐reported postsurgical social trajectories. Self‐report questionnaires were used to assess mood and health‐related quality of life (HRQOL) at the time of interview. Results There was a common sequence of social milestone achievement, spanning 20 years postsurgery. Typically, patients first (re)gained their license, then attempted educational and vocational gains, followed by establishing long‐term relationships and finally a family unit. Rare, intermittent seizures postsurgery did not appear to have detrimental effects on social trajectories. Those who experienced a reduction in seizures showed increased likelihood of attaining social milestones compared to those with ongoing seizures. Significance Achieving social milestones after epilepsy surgery may take considerably longer than patients are expecting prior to surgery. The pattern of social milestone outcome resembled a process of psychosocial development. These findings have important implications for presurgical counseling and postsurgical rehabilitation.

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Long term follow-up of the first 70 operated adults in the Goteborg Epilepsy Surgery Series with respect to seizures, psychosocial outcome and use of antiepileptic drugs

Abstract: Adult patients who are seizure-free 2 years after resective epilepsy surgery are most likely to still be seizure-free 10 years later. Most are working and have obtained a driving license.

Cited by 54 publications

References 34 publications

Clinical Value of the First Dedicated, Commercially Available Automatic Injector for Ictal Brain SPECT in Presurgical Evaluation of Pediatric Epilepsy: Comparison with Manual Injection

Clinical Value of the First Dedicated, Commercially Available Automatic Injector for Ictal Brain SPECT in Presurgical Evaluation of Pediatric Epilepsy: Comparison with Manual Injection

Langzeit-Outcome nach epilepsiechirurgischen Eingriffen

Identifying the trajectory of social milestones 15‐20 years after epilepsy surgery: Realistic timelines for postsurgical expectations

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