Long-term Seizure Outcome and Prognostic Factors After Extratemporal Epilepsy Surgery
Keywords:
Extratemporal lobe epilepsy, Engel classificationAbstract
Background: Surgery is an important therapeutic option in patients with intractable epilepsy. Seizure outcome after resective surgery for patients in extratemporal epilepsy vary tremendously in the literature with short duration time of follow-up.
Objective: To assess seizure outcome and prognostic factors in patients who had undergone extratemporal epilepsy surgery for management of intractable seizures.
Methods: Independent, experienced surgeon retrospectively reviewed a single surgeon database between 2003 and 2013 and identified 50 patients who underwent extratemporal epilepsy surgery for intractable seizure. We evaluated the correlation between the seizure outcome and the following clinical parameters (demographic data, preoperative factors including MRI brain and seizure information, location of resection, neuropathology reports and extent of resection). Multivariable analysis was performed to assess prognostic factors for seizure outcome.
Results: FForty-five patients were performed resective epilepsy surgery (frontal resection 42%, parietal resection 20%, occipital resection 6% and multilobar resection 22%). One patient underwent hemispherectomy (2%) and four patients did not undergo resection (8%) due to epileptogenic foci on cortical eloquent area. Forty-seven patients (94%) underwent two-staged operation for subdural grid implantation. Median follow-up was 4.67 years (range 0.67-9.33). Seizure remission was 36% and seizure cure was 20%. The postoperative Engel Class I outcome was 64% at 1 year, 48% at 2 years, 38% at 3 years and 32% at 5 years. On multivariable analysis, presence of generalized tonic-clonic seizure, (p=0.039) and incomplete resection of epileptogenic foci (p=0.01) were independent poor prognostic factors.
Conclusion: Extratemporal epilepsy surgery is effective in selected patients according to findings on long-term follow-up.
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References
Annegers JF. The Epidemiology of epilepsy. In: Wyllie E, editor. The Treatment of Epilepsy Principles & Practice. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 131-8.
Hauser WA. Incidence and prevalence. In: Engel J Jr, editor. Epilepsy: A Comprehensive Textbook. Philadelphia: Raven Publishers; 1997. p. 47-57.
Tellez-Zenteno JF, Pondal-Sordo M, Matijevic S, Wiebe S. National and regional prevalence of selfreported epilepsy in Canada. Epilepsia 2004 Dec; 45(12):1623-9.
Hauser WA. Epidemiology of intractable epilepsy. In: Luders H, editor. Epilepsy Surgery. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 55-61.
Jallon P. Epidemiology of drug-resistant epilepsies. Rev Neurol. (Paris) 2004 Jun;160:522-30.
Chinvarun Y. Thailand comprehensive epilepsy program; 2009.
French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, et al. Review efficacy and tolerability of the new antiepileptic drugs II treatment of refractory epilepsy : report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology, American Epilepsy Society. Neurology 2004;62(8):1261-73.
Engel J, Ness PCV, Rasmussen TB. Outcome with respect to epileptic seizures. In: Engel J, editor. Surgical Treatment of the Epilepsies, 2nd ed. New York: Raven Press; 1993. p. 609-21.
Spencer SS, Berg AT, Vickrey BG, Sperling MR, Bazil CW, Shinnar S, et al. Initial outcome in the multicenter study of epilepsy surgery. Neurology 2003;61: 1680-85.
Behrens E, Schramm J, Zentner J, Konig R. Surgical and neurological complications in a series of 708 epilepsy surgery procedures. J Neurosurg 1997;41: 1-9.
Spencer S, Huh L. Outcomes of epilepsy surgery in adults and children. Lancet Neurol 2008;7:525-37.
Téllez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Brain 2005;128: 1188-98.
Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001;345:311-18.
Elsharkawy AE, Alaa E, Pannek H, Schulz R, Hoppe M, Pahs G, et al. Outcome of extratemporal epilepsy surgery experience of a single center. J Neurosurg 2008;63:516-26.
Elsharkawy AE, Behne F, Oppel F, Pannek H, Schulz R, Hoppe M, et al. Long-term outcome of extratemporal epilepsy surgery among 154 adult patients. J Neurosurg 2008;108:676-86.
Siew JS, Lara E. Surgical outcomes in Patients with extratemporal epilepsy and subtle or normal magnetic resonance imaging findings. J Neurosurg 2013; 73:68-77.
Dario J, Jonathan D, Peter P. Seizure outcomes after resective surgery for extratemporal lobe epilepsy in pediatric patients. J Neurosurg 2013;12:126-33.
Noe K, Sulc V, Wang-Kisiel L, Wirrell E, Van Gompel JJ, Wetjen N, et al. Long-term outcomes after nonlesional extratemporal epilepsy surgery. JAMA Neurol 2013;70(8):1003-8.
Nobili L, Francione S, Mai R, Cardinale F, Castana L, Tassi L, et al. Surgical treatment of drug resistant nocturnal frontal lobe epilepsy. Brain 2007 Feb;130: 561-73.
Boesebeck F, Janszky J, Kellinghaus C, May T, Ebner A. Presurgical seizure frequency and tumoral etiology predict the outcome after extratemporal epilepsy surgery. J Neurol 2007 Aug;254(8):996-9.
Centeno RS, Yacubian EM, Sakamoto AC, Ferraz AFP, Junior HC, Cavalheiro S. Pre-surgical evaluation and surgical treatment in children with extratemporal epilepsy. Childûs Nervous System [Review] 2006 Aug; 22(8):945-59.
Yun CH, Lee SK, Lee SY, Kim KK, Jeong SW, Chung CK. Prognostic factors in neocortical epilepsy surgery: multivariate analysis. Epilepsia 2006 Mar; 47(3):574-9.
Tanriverdi T, Olivier NP, Olivier A. Quality of life after extratemporal epilepsy surgery: A prospective clinical study. Clin Neurol Neurosurg 2008 Jan;110(1): 30-7.
Jeha LE, Najm I, Bingaman W, Dinner D, WiddessWalsh P, Luders H. Surgical outcome and prognostic factors of frontal lobe epilepsy surgery. Brain 2007 Feb;130(2):574-84.
Lee SK, Lee SY, Kim DW, Lee DS, Chung CK. Occipital lobe epilepsy: clinical characteristics, surgical outcome and role of diagnostic modalities. Epilepsia 2005;46(5):688-95.
Kim CH, Chung CK, Lee SK, Lee YK, Chi JG. Parietal lobe epilepsy: surgical treatment and outcome. Stereotact Funct Neurosurg 2004; 82(4):175-85.
Dalmagro CL, Bianchin MM, Velasco TR, Alexandre V Jr, Walz R, Terra-Bustamante VC, et al. Clinical features of patients with posterior cortex epilepsies and predictors of surgical outcome. Epilepsia 2005 Sep; 46(9):1442-9.
Mcintosh AM, Averill CA, Kalnins RM, Mitchell L, Fabinyi GCA, Jackson GD, et al. Long-term seizure outcome and risk factors for recurrence after extratemporal epilepsy surgery. Epilepsia 2012; 53(6):970-78.
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