Long-term seizure outcome in patients initially seizure-free after resective epilepsy surgery

Yoon, Hong; Kwon, Helen L.; Mattson, Richard H.; Spencer, Dennis D.; Spencer, Susan S.

doi:10.1212/01.wnl.0000081226.51886.5b

Cited by 187 publications

(163 citation statements)

References 31 publications

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“…Neuronal kindling and secondary epileptogenesis may explain the higher rate of AED continuation in patients with longer disease duration or older age at surgery, and the superior outcome attained by early surgery. 14) The present study suggests that early surgical intervention after seizure onset is an important precondition for achieving seizure-free status without requiring AED treatment.…”

Section: Discussionmentioning

confidence: 72%

Preoperative Factors Associated With Antiepileptic Drug Withdrawal Following Surgery for Intractable Temporal Lobe Epilepsy

Maehara

Ohno

2011

Neurol. Med. Chir.(Tokyo)

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The outcomes of postoperative antiepileptic drug (AED) cessation after temporal lobe epilepsy surgery were investigated to identify the preoperative factors associated with seizure-free status without drug treatment in 40 patients who underwent resective epilepsy surgery between 2000 and 2007 for the treatment of complex partial seizures of the type typically associated with temporal lobe epilepsy. All patients were followed up for at least 3.5 years after surgery. After the numbers and types of AEDs used as preoperative and postoperative treatments were determined, the patients who obtained seizure-free outcome for at least 2 years after AED cessation were analyzed. Sex, age at surgery, age at seizure onset, time to operation, seizure frequency, operation side, invasive study, pathological types (hippocampal sclerosis or others), history of generalized convulsive seizures, and number of preoperative AEDs were analyzed as factors potentially associated with seizure-free status without drug treatment. In total, 35% of the patients who underwent temporal lobe epilepsy surgery achieved seizure-free status without drugs. The mean number AEDs fell from 2.1 preoperatively to 1.2 after the surgery. Seizures recurred in 18% of the patients after AED withdrawal. A shorter duration from seizure onset to surgery was found to be significantly related to successful withdrawal of postoperative AED treatment. Our results suggested that early surgical intervention after seizure onset is an important precondition for achieving seizure-free status without drugs after temporal lobe epilepsy surgery.

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Section: Discussionmentioning

confidence: 72%

Preoperative Factors Associated With Antiepileptic Drug Withdrawal Following Surgery for Intractable Temporal Lobe Epilepsy

Maehara

Ohno

2011

Neurol. Med. Chir.(Tokyo)

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“…All of the included studies were designed to assess the longterm effectiveness and safety of surgery for medically intractable localized epilepsy. The majority of included studies examined the long-term effectiveness of temporal lobectomy; three included studies evaluated the effectiveness of other surgical procedures in addition to temporal lobectomy (Rougier et al, 1992;Spencer et al, 2005;Yoon et al, 2003). Other procedures assessed by these studies included frontal, occipital, and parietal lobectomies.…”

Section: Resultsmentioning

confidence: 99%

Seizure and the Risk for Seizure Recurrence Among Individuals Who Have Undergone Surgery for Epilepsy

Tregear

Williams

2009

Proceedings of the 5th International Driving Symposium on Human Factors in Driver Assessment, Training, and Vehicle Design : Dr

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Summary: Epilepsy is a central nervous system disorder for which recurrent seizures are the main symptom. Seizures resulting from epilepsy may culminate in unpredictable and sudden incapacitation, and thus are of significant concern to those interested in driver safety. Surgical therapy is one of the main treatment options for patients who do not respond to pharmacotherapy. Although approximately two thirds of individuals who undergo the most common types of surgery for epilepsy become seizure free, a significant proportion of these individuals will experience seizure recurrence. A systematic review and metaanalysis was conducted to examine the likelihood of seizure recurrence among individuals who have undergone surgery for epilepsy. Specifically, we were interested in quantifying the relationship between time since last seizure and the likelihood that a seizure will occur within the following year. Our results indicate that the longer the time that has elapsed since the occurrence of the last seizure, the lower the risk for seizure recurrence in the following year. The average annual risk for experiencing seizure recurrence among individuals who have remained seizure free for ≥8 years is less than 2% and less than 1% for those who have remained seizure free for ≥10 years. These findings have important implications for regulatory agencies with responsibility for road safety; particularly those agencies that regulate safety sensitive industries.

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“…27) The patient attrition rate, 26) or the rate of loss of contact with patients, also affects the long-term outcome of studies and may be closely related to outcome status, especially for patients with poor outcome after surgery. 11,19,34) Such drop-out bias may explain some of the discrepancies between the findings of different studies. 8,9,34) Two years is considered the minimum follow-up period necessary for reliable assessment of postoperative seizure resolution and to make predictions about long-term outcome.…”

Section: Discussionmentioning

confidence: 99%

“…11,19,34) Such drop-out bias may explain some of the discrepancies between the findings of different studies. 8,9,34) Two years is considered the minimum follow-up period necessary for reliable assessment of postoperative seizure resolution and to make predictions about long-term outcome. 8) Only a few reports have examined the outcome of epilepsy surgery after more than 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,10,22) In the present study, the follow-up period was 5 years or more, with a mean of about 12 years, so is one of the longest reported follow-up periods of patients undergoing epilepsy surgery. 5,6,19,25,28,34) The proportion of patients remaining seizure-free postoperatively for several years shows a progressive decline, 2,5,8,25,34) although half of the patients who suffered relapse had, at most, one seizure per year. 5,34) Kindling and maturation of the epileptogenic focus may be involved in the delayed recurrence of seizures.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Seizure Outcome in Patients Undergoing Resection of Lesions Detected by Magnetic Resonance Imaging

Moritake

Mikuni

Akiyama

et al. 2008

Neurol. Med. Chir.(Tokyo)

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The long-term efficacy of resective surgery was investigated in patients with lesions detected by magnetic resonance (MR) imaging. Thirty of 47 patients who had undergone lesionectomy between 1987-2001 were followed up by questionnaire. Patients with extratemporal resections outnumbered those with temporal lobe resections. The mean follow-up period was 12.4 ± 3.7 years. Outcomes were graded according to Engel's criteria, and an arbitrary seizure outcome score was given for quantitative assessment. The mean seizure outcome scores were significantly lower in the early childhood (less than 3 years) onset group than in the late childhood (3 to 15 years) onset group, and significantly lower in the extratemporal resection of the cortical dysplasia group than in the temporal resection and the extratemporal resection of non-cortical dysplasia groups. This study indicated that lesionectomy based on MR imaging findings in patients with intractable epilepsy achieved effective long-term seizure control, and the outcome was related mainly to the pathology of the epileptogenic lesions and the temporal or extratemporal location.

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Long-term seizure outcome in patients initially seizure-free after resective epilepsy surgery

Cited by 187 publications

References 31 publications

Preoperative Factors Associated With Antiepileptic Drug Withdrawal Following Surgery for Intractable Temporal Lobe Epilepsy

Preoperative Factors Associated With Antiepileptic Drug Withdrawal Following Surgery for Intractable Temporal Lobe Epilepsy

Seizure and the Risk for Seizure Recurrence Among Individuals Who Have Undergone Surgery for Epilepsy

Long-Term Seizure Outcome in Patients Undergoing Resection of Lesions Detected by Magnetic Resonance Imaging

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