Temporal Lobe Epilepsy Surgery: Outcome, Complications, and Late Mortality Rate in 215 Patients

Salanova, Vicenta; Markand, Omkar N.; Worth, Robert M.

doi:10.1046/j.1528-1157.2002.33800.x

Cited by 176 publications

(115 citation statements)

References 12 publications

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“…12 Salanova et al demonstrated that people who continued to have seizures after surgery had a SMR of 7.4 in contrast to those who were seizure free postsurgery (SMR=1.7); 2/11 deaths were due to suicide. 13 Likewise, Hennessy et al demonstrated that overall post surgical patients had higher mortality rate compared to the general population (SMR=4.5). 8 One of their 20 deaths were due to suicide in a subject who had post-surgical depression but was seizure free.…”

Section: Resultsmentioning

confidence: 97%

Suicide outcomes after resective epilepsy surgery

Hamid

Devinsky

Vickrey

et al. 2012

Epilepsy & Behavior

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People with epilepsy have a higher risk for suicide than people without epilepsy. The relationship between seizure control and suicide is controversial. A standardized protocol to record history, diagnostic testing, and neuropsychiatric assessments was administered. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BDA) were administered presurgically and yearly for up to five years. Of the 396 enrolled, 4/27 deaths were attributed to suicide. The standardized mortality ratio, compared to suicides in the U.S. population and adjusted for age and gender, was 13.3 (95% CI=3.6, 34.0). Only one patient had a BDI score suggestive of severe depression (BDI=33), one had depressive symptoms that do not the meet the depressive range (BDI=7), while the other two reported no depressive symptoms. Two of the patients reported moderate to severe anxiety symptoms (BDI = 17 and 21, respectively). Suicide may occur after epilepsy surgery even when patients report excellent seizure control.

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Section: Resultsmentioning

confidence: 97%

Suicide outcomes after resective epilepsy surgery

Hamid

Devinsky

Vickrey

et al. 2012

Epilepsy & Behavior

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“…Evaluation of 215 patients with temporal lobe epilepsy found 3 of 148 (2%) seizure-free patients died after surgery, compared with 8 of 67 (11.9%) non-seizure-free patients. 26) In a series of 583 patients who underwent epilepsy surgery, only one of 258 (0.4%) patients with no recurrent seizure died, whereas 18 of 325 (5.5%) patients with recurrent seizure died. 29) These findings suggest that mortality after epilepsy surgery is associated with seizure persistence and successful surgery reduces the mortality rate among patients with MTLE.…”

Section: Discussionmentioning

confidence: 99%

“…27,33) Resective surgery for MTLE has shown favorable outcome and safety, but is not free from failure of seizure control, morbidity, and relapse of seizure. 1,23,26,28,32) Given such faults of conventional surgery, other treatment options should be developed with better outcome and lower morbidity than open surgery.…”

Section: Introductionmentioning

confidence: 99%

Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

Kawamura

Onishi

Kohda

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Gamma knife radiosurgery (GKRS) for mesial temporal lobe epilepsy (MTLE) has been proposed as an alternative to surgical resection. We report serious adverse effects of the treatment after follow-up periods over 9 years in 11 patients treated with GKRS between 1997 and 2000. The target volume of the entorhinoamygdalohippocampectomy area was 4.8-17.1 ml. Marginal dose of 20-25 Gy to the 50% isodose was delivered. One patient was drowned after suffering seizure 7 months after GKRS. Two patients did not show any reduction in seizure frequency over 9 and 18 months. Both patients requested open surgery and became seizure-free postoperatively. Four of the other eight patients were classified as Engel's class I within 4 years after GKRS. One of the four patients experienced symptomatic radiation-induced cerebral edema transiently, one developed radiation necrosis and required surgery 5 years after GKRS, and one developed cognitive impairment with hemiparesis 10 years after GKRS. Magnetic resonance (MR) imaging showed a large cyst in the irradiated temporal lobe. This patient recovered fully after the cyst excision. Only one patient became seizure-free and antiepileptic drug-free without symptomatic radiation-induced complications. However, MR imaging revealed abnormal enhancement, cyst formation, and diffuse white matter change in the irradiated temporal lobe 9 years after GKRS. GKRS for MTLE causes adverse effects of delayed seizure remission and symptomatic radiationinduced complications. Therefore, GKRS cannot be considered as an ideal alternative to surgery for MTLE. Long-term follow-up studies including MR imaging with contrast medium are required for the patients even after successful control of seizures.

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“…The amygdala and hippocampus are excised en bloc. Ninety percent seizure free results are expected [5].…”

Section: Resectionsmentioning

confidence: 96%