Factors affecting seizure outcome after epilepsy surgery: an observational series

Bell, Gail S.; Tisi, Jane de; Gonzalez-Fraile, Juan Carlos; Peacock, Janet L.; McEvoy, Andrew W.; Harkness, William; Foong, J; Pope, Rebecca; Diehl, Beate; Sander, Josemir W.; Duncan, John S.

doi:10.1136/jnnp-2017-316211

Cited by 55 publications

(63 citation statements)

References 31 publications

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“…Conversely, the occurrence of generalized tonicclonic seizures, a normal MRI, extratemporal onset, psychiatric comorbidity, and learning disability reduce the chances. 11…”

Section: Reasons For Underutilization Of Epilepsy Surgerymentioning

confidence: 99%

“…14 Seizure outcome needs to be considered in the long term, with the recognition that there is an attrition rate of seizure freedom over the following 10 to 20 years, and some may remit after some years. 11 Evaluation of epilepsy surgery usefully includes HRQOL measures that determine effects on school and work performance, domiciliary arrangements, driving, interpersonal relationships, memory, and other cognitive functions.…”

Section: Measuring Outcomementioning

confidence: 99%

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Getting the best outcomes from epilepsy surgery

Vakharia

Duncan

Witt

et al. 2018

Annals of Neurology

178

139

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Neurosurgery is an underutilized treatment that can potentially cure drug‐refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guided surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures and associated outcome data. We aim to dispel myths that may inhibit physicians from referring and patients from considering neurosurgical intervention for drug‐refractory focal epilepsies. Ann Neurol 2018;83:676–690

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“…Conversely, the occurrence of generalized tonicclonic seizures, a normal MRI, extratemporal onset, psychiatric comorbidity, and learning disability reduce the chances. 11…”

Section: Reasons For Underutilization Of Epilepsy Surgerymentioning

confidence: 99%

Section: Measuring Outcomementioning

confidence: 99%

Getting the best outcomes from epilepsy surgery

Vakharia

Duncan

Witt

et al. 2018

Annals of Neurology

178

139

View full text Add to dashboard Cite

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“…These differences may be due to multiple factors, including differences in patient population, presurgical evaluation, and surgical techniques. Our patients had had 7.7 different AED trials on average, and the use of a higher number of AEDs is known to affect postsurgical seizure outcome adversely . Mean postsurgical follow‐up duration was 9.7 years, compared to 5 years in the original report, and seizure freedom rates are known to decrease over time .…”

Section: Discussionmentioning

confidence: 85%

“…Our patients had had 7.7 different AED trials on average, and the use of a higher number of AEDs is known to affect postsurgical seizure outcome adversely. 7 Mean postsurgical follow-up duration was 9.7 years, compared to 5 years in the original report, and seizure freedom rates are known to decrease over time. 14 Our definition of postsurgical seizure freedom was also slightly different from that used by Dugan et al, as we used the more recent ILAE classification.…”

Section: Discussionmentioning

confidence: 85%

“…Most experts recommend that patients who fail two or more AED trials should be referred to a specialized epilepsy center for presurgical evaluation . However, not all drug‐resistant patients are equally suitable candidates for epilepsy surgery and selection for surgery as well as the ultimate outcome of surgery depend on multiple factors . In most specialized epilepsy centers, selection of surgical candidates does not follow standard procedures .…”

Section: Introductionmentioning

confidence: 99%

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The Epilepsy Surgery Grading Scale: Validation in an independent population with drug‐resistant focal epilepsy

et al. 2019

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The Epilepsy Surgery Grading Scale (ESGS) is a simple tool that predicts a patient's likelihood of progressing to resective surgery and becoming seizure‐free. The aim of our study was to validate the ESGS in an independent patient cohort. We retrospectively calculated the ESGS score for adult patients with drug‐resistant focal epilepsy undergoing presurgical evaluation at two reference centers for drug‐resistant epilepsy in Belgium. We classified patients into ESGS grade 1 (most favorable), grade 2 (intermediate), and grade 3 (least favorable). We assessed progression to surgery and postsurgical seizure freedom. A total of 238 patients underwent presurgical evaluation (presurgical cohort), of whom 140 progressed to surgery (surgical cohort). In the presurgical cohort, we observed significant differences in rates of surgery and in rates of seizure freedom between grades 1, 2, and 3. In the surgical cohort, we observed significant differences in rates of seizure freedom between grades 1 and 2 and between grades 1 and 3. We confirm the usefulness of the ESGS for the prognostic stratification of patients with drug‐resistant focal epilepsy undergoing presurgical evaluation. Our results support the use of the ESGS in the decision process of presurgical evaluation in clinical practice.

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