The long-term outcomes of epilepsy surgery

Mohan, Midhun, Keller, Simon ORCID: 0000-0001-5247-9795, Nicolson, Andrew, Biswas, Shubhabrata, Smith, David, Farah, Jibril Osman, Eldridge, Paul and Wieshmann, Udo (2018) The long-term outcomes of epilepsy surgery. PLOS ONE, 13 (5). e0196274-.

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Abstract

<h4>Objective</h4>Despite modern anti-epileptic drug treatment, approximately 30% of epilepsies remain medically refractory and for these patients, epilepsy surgery may be a treatment option. There have been numerous studies demonstrating good outcome of epilepsy surgery in the short to median term however, there are a limited number of studies looking at the long-term outcomes. The aim of this study was to ascertain the long-term outcome of resective epilepsy surgery in a large neurosurgery hospital in the U.K.<h4>Methods</h4>This a retrospective analysis of prospectively collected data. We used the 2001 International League Against Epilepsy (ILAE) classification system to classify seizure freedom and Kaplan-Meier survival analysis to estimate the probability of seizure freedom.<h4>Results</h4>We included 284 patients who underwent epilepsy surgery (178 anterior temporal lobe resections, 37 selective amygdalohippocampectomies, 33 temporal lesionectomies, 36 extratemporal lesionectomies), and had a prospective median follow-up of 5 years (range 1-27). Kaplan-Meier estimates showed that 47% (95% CI 40-58) remained seizure free (apart from simple partial seizures) at 5 years and 38% (95% CI 31-45) at 10 years after surgery. 74% (95% CI 69-80) had a greater than 50% seizure reduction at 5 years and 70% (95% CI 64-77) at 10 years. Patients who had an amygdalohippocampectomy were more likely to have seizure recurrence than patients who had an anterior temporal lobe resection (p = 0.006) and temporal lesionectomy (p = 0.029). There was no significant difference between extra temporal and temporal lesionectomies. Hippocampal sclerosis was associated with a good outcome but declined in relative frequency over the years.<h4>Conclusion</h4>The vast majority of patients who were not seizure free experienced at least a substantial and long-lasting reduction in seizure frequency. A positive long-term outcome after epilepsy surgery is possible for many patients and especially those with hippocampal sclerosis or those who had anterior temporal lobe resections.

Item Type:	Article
Uncontrolled Keywords:	Amygdala, Hippocampus, Temporal Lobe, Humans, Epilepsy, Epilepsy, Temporal Lobe, Treatment Outcome, Neurosurgical Procedures, Prospective Studies, Drug Resistance, Time Factors, Adult, Female, Male, Kaplan-Meier Estimate, United Kingdom
Depositing User:	Symplectic Admin
Date Deposited:	18 May 2018 15:19
Last Modified:	19 Jan 2023 06:33
DOI:	10.1371/journal.pone.0196274
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3021476