Natural History of Recurrent Seizures After Resective Surgery for Epilepsy

Abstract

Seizures persist or recur in 20-60% of patients after resective surgery for intractable partial epilepsy. Further information about the natural course of these seizures is lacking in the literature. During one decade of epilepsy surgery at a single institution, we identified 72 patients with recurrent postoperative seizures after resective procedures for epilepsy. Prospectively compiled seizure diaries, hospital records, and outpatient office records were reviewed and supplemented by telephone communications to assess subsequent seizure frequency. Follow-up data was available ranging from 6 months to 7 years 5 months (mean 3 years 5 months). The likelihood of persistent seizures and recurrent intractability was examined with life-tables. Seizures recurred within the first postoperative year in 86% of patients and were similar to preoperative events in 74% of patients. After the first seizure recurrence, there was 80% likelihood of persistent seizures in the next 6 years and 40% likelihood of intractability (more than one seizure a month despite optimal medical therapy). The interval until recurrence within the first postoperative year did not affect the likelihood of subsequent seizures or intractability. Late seizure recurrence (after the first year) was not associated with any instances of subsequent intractability. Recurrent seizures after extratemporal resections were more likely to become persistent and intractable than seizures recurring after temporal resections. This information provides rational prognostication and assists in counseling patients with recurrent seizures after resective surgery for intractable epilepsy.

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

“…5,12,14,21,26,30,32) On the other hand, long-term freedom from seizures is consistently worse after extratemporal surgery and palliative procedures, 5,12,28) and recurrent seizures may be more intractable after extratemporal resection than after temporal resection. 31) These findings are consistent with the overall poor outcome after resection in the extratemporal region because of the more extensive and frequently unresectable epileptogenic foci. 33) The reasons for poor outcomes in extratemporal lobe epilepsy remain unclear, although secondary epileptogenesis may be important.…”

Correlation of widespread preoperative magnetic resonance imaging changes with unsuccessful surgery for hippocampal sclerosis

“…Explanations for unsuccessful surgery have included the presence of bitemporal structural abnormalities, extraternporal lesions, conservative removal of the diseased hippocampus, and widespread structural pathology (i.e., persisting epileptogenic zones) [4,12,22,231. [24], it renders it unlikely.…”

Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications

“…37,51,64,81,82,84,85 In the remaining one-third of patients, seizures usually recur during the first postoperative year, 37,48,97 although the percentage of patients who remain seizure free may decline with longer follow-up, with reported rates as low as 53% for patients with at least 5 years of follow-up and 41% for 10 years. 3,7,28,30,48,64,90 Recent data suggest that the histopathological abnormalities underlying surgically treated drug-resistant MTLE are the main factor predictive of seizure outcome.…”