Seizure outcome and its predictors after frontal lobe epilepsy surgery

P, Joseph Samuel; Menon, Ramshekhar; Chandran, Anuvitha; Thomas, Sanjeev V; Vilanilam, George C; Abraham, Mathew; Radhakrishnan, Ashalatha

doi:10.1111/ane.13139

Cited by 14 publications

(16 citation statements)

References 25 publications

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“…The moderate correlation of age at surgery and epilepsy duration in our study (r = .58) supports this consideration and was also reported by other authors. 16 Whereas other authors found extratemporal resections to be associated with worse seizure outcome, 8,[29][30][31] we found no such association in our cohort. On the other hand, studies regarding explicit late relapse found the localization of resection not to influence the risk of late seizure recurrence.…”

Section: Discussioncontrasting

confidence: 79%

Epilepsy surgery: Late seizure recurrence after initial complete seizure freedom

et al. 2021

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Section: Discussioncontrasting

confidence: 79%

Epilepsy surgery: Late seizure recurrence after initial complete seizure freedom

et al. 2021

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“…Negative experiences were commonly reported even though the proportion of seizure-free patients was high in this study population (71%), compared to what is normally reported in FLR outcome studies [43,44]. This is an important finding since patients and relatives tend to focus on the chances of seizure freedom and there could be a tendency to hope and believe that the majority of the patients' problems would resolve if seizure freedom is achieved.…”

Section: Findings Regarding Negative Experiences After Flrmentioning

confidence: 54%

Experiences of emotional and psychosocial functioning after frontal lobe resection for epilepsy

Ljunggren

Winblad

Graneheim

et al. 2021

Epilepsy & Behavior

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Purpose: Frontal lobe resection (FLR) is the second most common epilepsy surgery procedure in adults. Few studies address neuropsychological consequences after FLR. The aim of this study was to explore patients' and relatives' experiences of cognitive, emotional and social cognitive functioning after frontal lobe epilepsy surgery. Methods: Semi-structured interviews were held with 14 patients having gone through FLR as adults during the years 2000-2016 and 12 of their relatives. Interviews were audio-recorded, transcribed and analyzed with inductive qualitative content analysis. Results: Positive as well as negative consequences were described both by patients and relatives. Feelings of relief and an increased capacity to experience emotions of well-being were mainly experienced as related to seizure freedom. A newfound autonomy and a more grown-up identity as opposed to a selfimage based on epilepsy was also highlighted. However, results also showed that even for seizure free patients, FLR could give rise to negative experiences, the most prominent of which were mental fatigue, lowered mood and social withdrawal. Coping strategies included planning ahead to avoid mental exhaustion. Over all, respondents considered that the epilepsy surgery had been a risk well worth taking and that positive consequences outweighed the negative ones. Conclusions: This study shows a range of positive as well as negative outcomes after FLR for epilepsy. The findings indicate that lowered mood and mental fatigue could affect the life situation in a negative way, regardless of seizure outcome. This is important to consider in the preoperative counselling of patients and their families, as well as in the postsurgical follow-up. It is also crucial that the epilepsy surgery team has the possibility to offer rehabilitation and support to families regarding these aspects after surgery.

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“…The variables evaluated as potential predictors were: a) age at diagnosis of epilepsy and at the time of surgery; b) medical history (initial precipitating factors related to epilepsy in the prenatal, perinatal, or postnatal stage); c) seizure semiology and monthly frequency; d) preoperative electroencephalogram (interictal EEG, ictal onset) and neuroimaging findings; e) type of surgery; f) results of intraoperative electrocorticography (ECoG) before and after surgery; g) anatomopathological studies; h) postoperative electroencephalogram (EEG) and magnetic resonance imaging (MRI) as well as i) the occurrence of seizures before and after six months. [4][5][6][7]9] Preoperative evaluation [6,10] All patients were evaluated in a non-invasive way, with prolonged video-EEG monitoring and electrodes placed according to the international 10-20 system and additional electrodes depending on the topography of the epileptogenic zone (EZ). The interictal epileptiform activity was classified as ipsilateral whenever it was consistent with the ictal onset or bilateral zone when it occurred in both hemispheres.…”

Section: Methodsmentioning

confidence: 99%

“…After the first year, the cases were classified according to the Engel Class Outcome System, Engle I was considered a good prognosis (seizure freedom) and Engel II to IV a recurrence of seizures, short-term follow-up (one year). [4,7]…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…[2] 20% of patients who underwent surgery showed the extratemporal location, predominantly in the frontal lobe. [3,4] The outcomes of different series of extratemporal surgery are varied. West et al [5] found 30 to 50% of seizure freedom (Engel I), Morales et al [6], in Cuba, found 52.6% of patients in Engel I during the first year and 41.1% after two years of follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Short-Term Seizure Recurrence in Extratemporal Epilepsy Surgery

Santos¹

2021

JNNS

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Introduction: Drug-resistant extratemporal epilepsy is the second cause of referral to epilepsy surgery. Objectives: To identify factors associated with short-term seizure recurrence following extratemporal epilepsy surgery. Materials and Methods: We performed a retrospective study of 19 consecutive patients who underwent surgery for drug-resistant extratemporal epilepsy at the National Institute of Neurology and Neurosurgery of Havana, Cuba, from September 2014 to October 2019. All patients had at least one year of postoperative follow-up. Fisher's exact test was used to search for an association between dichotomous variables. A value of p≤0.05 was considered significant. Results: After one year of follow-up, seizure freedom reached 31.6% (Engel I) and 36.8% showed significant improvement in the number of seizures (Engel II). The frontal location (p=0.046) and incomplete resection of the epileptogenic zone (p=0.017), bilateral interictal discharges on the preoperative electroencephalogram (EEG) (p=0.017), the presence of epileptiform discharges on the postsurgical EEG (p=0.001), and the occurrence of seizures after the sixth month of surgery (p=0.001), were associated with seizures recurrence. Conclusions: After one year, 31.6% of patients operated on for extratemporal epilepsy were seizure-free. The incomplete resection of the epileptogenic zone and the presence of epileptogenic discharges in the postsurgical EEG, and the presence of seizures after the sixth month of surgery were the most significant factors of seizure recurrence.

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Seizure outcome and its predictors after frontal lobe epilepsy surgery

Cited by 14 publications

References 25 publications

Epilepsy surgery: Late seizure recurrence after initial complete seizure freedom

Epilepsy surgery: Late seizure recurrence after initial complete seizure freedom

Experiences of emotional and psychosocial functioning after frontal lobe resection for epilepsy

Factors Associated with Short-Term Seizure Recurrence in Extratemporal Epilepsy Surgery

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