Patients Remain Seizure-Free Long After Epilepsy Surgery

Seizure recurrence varies with the type of surgical treatment

FRIDAY, Oct. 14 (HealthDay News) -- Approximately half of patients with refractory focal epilepsy who undergo surgery remain seizure-free in the long term following epilepsy surgery, with seizure recurrence varying with the type of surgery, according to a study published in the Oct. 15 issue of The Lancet.

Jane de Tisi, from University College London, and colleagues established patterns of seizure remission and relapse after epilepsy surgery to identify the long-term outcome of surgery in patients with refractory focal epilepsy. A total of 615 adults who underwent 497 anterior temporal resections, 40 temporal lesionectomies, 40 extratemporal lesionectomies, 20 extratemporal resections, 11 hemispherectomies, and seven palliative procedures were analyzed. Participants were followed up annually for a median of eight years. The time to first seizure was assessed using Kaplan-Meier survival analysis.

The investigators found that 52 and 47 percent of the patients remained seizure free (apart from simple partial seizures) at five and ten years after surgery, respectively. Seizure recurrence was more likely in those who underwent extratemporal resections than in those who had anterior temporal resections, whereas there was no difference in seizure recurrence after lesionectomy or anterior lobe resection. The presence of simple partial seizures in the first two years after temporal lobe surgery increased the chances of subsequent seizures with impaired awareness. Prolonged seizure-free time correlated with less likelihood of relapse; the longer seizures continued, the less likely remission. Of the 365 seizure-free individuals, 28 percent had discontinued drugs at the latest follow-up.

"For seizure outcome, surgery is successful for many individuals in whom antiepileptic drugs have not been effective," the authors write.

Several authors disclosed financial relationships with the pharmaceutical industry.

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