Long-term seizure and psychosocial outcomes after resective surgery for intractable epilepsy |
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| Institution: | 1. Sector of Neuropsychology for Children and Adolescents, Hp KG 01.327.1, Brain Center Rudolf Magnus, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands;2. Bio Research Center for Children, Wekeromseweg 8, 6816 VS Arnhem, The Netherlands;3. Department of Child Neurology, Hp KC 03.063.0, Brain Center Rudolf Magnus, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands;4. Department of Neurosurgery, Hp G 03.124, Brain Center Rudolf Magnus, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands;5. SEIN, Epilepsy Institute of the Netherlands Foundation, Location Meer en Bosch, P.O. Box 540, 2103 SW Heemstede, The Netherlands;6. Department of Behavioural Sciences, Kempenhaeghe Expertise Centre for Epileptology, Sleep Medicine and Neurocognition, P.O. Box 61, 5590 AB Heeze, The Netherlands;7. Donders Institute for Brain, Cognition and Behaviour, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands;1. School of Medicine, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK;2. Swansea University Medical School, Swansea University, Swansea SA2 8PP, UK;3. The Wales Epilepsy Centre, Department of Neurology, University Hospital Wales, Cardiff CF14 4XW, UK;1. Australian Centre for Health Engagement, Evidence and Values, School of Health & Society, University of Wollongong, Wollongong, Australia;2. Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia;3. Royal Prince Alfred Hospital, Sydney, Australia;4. University of Sydney, Sydney, Australia;5. Royal North Shore Hospital, Sydney, Australia;6. Westmead Hospital, Westmead, Australia;1. Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;2. Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;3. Psychiatry and Psychology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA |
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| Abstract: | Resective surgery is considered an effective treatment for refractory localization-related epilepsy. Most studies have reported seizure and psychosocial outcomes of 2–5 years postsurgery and a few up to 10 years. Our study aimed to assess long-term (up to 15 years) postsurgical seizure and psychosocial outcomes at our epilepsy center. The Henry Ford Health System Corporate Data Store was accessed to identify patients who had undergone surgical resection for localization-related epilepsy from 1993 to 2011. Demographics including age at epilepsy onset and surgery, seizure frequency before surgery, and pathology were gathered from electronic medical records. Phone surveys were conducted from May 2012 to January 2013 to determine patients' current seizure frequency and psychosocial metrics including driving and employment status and use of antidepressants. Surgical outcomes were based on Engel's classification (classes I and II = favorable outcomes). McNemar's tests, chi-square tests, two sample t-tests, and Wilcoxon two sample tests were used to analyze the relationships of psychosocial and surgical outcomes with demographic and surgical characteristics. A total of 470 patients had resective epilepsy surgery, and of those, 50 (11%) had died since surgery. Of the remaining, 253 (60%) were contacted with mean follow-up of 10.6 ± 5.0 years (27% of patients had follow-up of 15 years or longer). Of the patients surveyed, 32% were seizure-free and 75% had a favorable outcome (classes I and II). Favorable outcomes had significant associations with temporal resection (78% temporal vs 58% extratemporal, p = 0.01) and when surgery was performed after scalp EEG only (85% vs 65%, p < 0.001). Most importantly, favorable and seizure-free outcome rates remained stable after surgery over long-term follow-up i.e., < 5 years (77%, 41%), 5–10 years (67%, 29%), 10–15 years (78%, 38%), and > 15 years (78%, 26%)]. Compared to before surgery, patients at the time of the survey were more likely to be driving (51% vs 35%, p < 0.001) and using antidepressants (30% vs 22%, p = 0.013) but less likely to be working full-time (23% vs 42%, p < 0.001). A large majority of patients (92%) considered epilepsy surgery worthwhile regardless of the resection site, and this was associated with favorable outcomes (favorable = 98% vs unfavorable = 74%, p < 0.001). The findings suggest that resective epilepsy surgery yields favorable long-term postoperative seizure and psychosocial outcomes. |
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