Long-term outcomes of surgical treatment for epilepsy in adults with regard to seizures, antiepileptic drug treatment and employment

Malmgren, Kristina; Edelvik, Anna

doi:10.1016/j.seizure.2016.10.015

Cited by 71 publications

(67 citation statements)

References 69 publications

(117 reference statements)

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“…Stereo-electroencephalography electrodes were implanted stereotactically using an image-guided system 29 (an average of 8.2 intracranial SEEG electrodes [range [5][6][7][8][9][10][11][12][13][14] per patient). Electrode positions were tailored for each patient and the clinical hypothesis.…”

Section: Eeg Recordingsmentioning

confidence: 99%

“…[1][2][3][4] Epilepsy surgery foremost requires the identification of the epileptogenic zone (EZ), defined as the brain area indispensable for seizure generation. The fact, however, that surgical outcomes are unfavorable in 40%-50% of well-selected patients, 6 suggests that the SOZ is a suboptimal approximation for the EZ, and that new biomarkers are needed. The fact, however, that surgical outcomes are unfavorable in 40%-50% of well-selected patients, 6 suggests that the SOZ is a suboptimal approximation for the EZ, and that new biomarkers are needed.…”

Section: Introductionmentioning

confidence: 99%

“…5 The current gold standard for identification of the EZ is the seizure-onset zone (SOZ). The fact, however, that surgical outcomes are unfavorable in 40%-50% of well-selected patients, 6 suggests that the SOZ is a suboptimal approximation for the EZ, and that new biomarkers are needed.…”

Section: Introductionmentioning

confidence: 99%

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NREM sleep is the state of vigilance that best identifies the epileptogenic zone in the interictal electroencephalogram

et al. 2019

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Objective: Interictal epileptiform anomalies such as epileptiform discharges or highfrequency oscillations show marked variations across the sleep-wake cycle. This study investigates which state of vigilance is the best to localize the epileptogenic zone (EZ) in interictal intracranial electroencephalography (EEG). Methods: Thirty patients with drug-resistant epilepsy undergoing stereo-EEG (SEEG)/sleep recording and subsequent open surgery were included; 13 patients (43.3%) had good surgical outcome (Engel class I). Sleep was scored following standard criteria. Multiple features based on the interictal EEG (interictal epileptiform discharges, high-frequency oscillations, univariate and bivariate features) were used to train a support vector machine (SVM) model to classify SEEG contacts placed in the EZ. The performance of the algorithm was evaluated by the mean area under the receiver-operating characteristic (ROC) curves (AUCs) and positive predictive values (PPVs) across 10-minute sections of wake, non-rapid eye movement sleep (NREM) stages N2 and N3, REM sleep, and their combination.Results: Highest AUCs were achieved in NREM sleep stages N2 and N3 compared to wakefulness and REM (P < .01). There was no improvement when using a combination of all four states (P > .05); the best performing features in the combined state were selected from NREM sleep. There were differences between good (Engel I) and poor (Engel II-IV) outcomes in PPV (P < .05) and AUC (P < .01) across all states. The SVM multifeature approach outperformed spikes and high-frequency oscillations (P < .01) and resulted in results similar to those of the seizure-onset zone (SOZ; P > .05). Significance: Sleep improves the localization of the EZ with best identification obtained in NREM sleep stages N2 and N3. Results based on the multifeature classification in 10 minutes of NREM sleep were not different from the results achieved by the SOZ based on 12.7 days of seizure monitoring. This finding might ultimately result in a more time-efficient intracranial presurgical investigation of focal epilepsy. K E Y W O R D Sconnectivity, drug-resistant epilepsy, high-frequency oscillations, machine learning, sleep-wake cycle | 2405 KLIMES Et aL.

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Section: Eeg Recordingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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NREM sleep is the state of vigilance that best identifies the epileptogenic zone in the interictal electroencephalogram

et al. 2019

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“…Several studies have been published looking at predictors of both short-term and long-term outcomes after epilepsy surgery. The predictors of good short-term postoperative seizure freedom include: complete surgical resection, presence of hippocampal sclerosis, MRI positive (abnormal pre-operative MRI), no intracranial monitoring being performed, concordance with EEG and pre-operative MRI, no evidence of focal cortical dysplasia, no evidence of malformation of cortical development, a history of febrile seizures, presence of a tumour, unilateral interictal spikes and a right sided resection [ 19 – 21 ]. The predictors of bad postoperative seizure freedom include: long duration of epilepsy prior to surgery [ 18 , 22 – 26 ], higher age at surgery [ 9 , 16 , 27 , 28 ], high seizure frequency at baseline (pre-surgery) [ 22 , 29 ], generalised convulsive seizures at baseline (pre-surgery) [ 12 , 27 , 30 ], early postoperative seizures [ 31 – 33 ] and postoperative interictal epileptiform discharges [ 34 – 36 ].…”

Section: Introductionmentioning

confidence: 99%

The long-term outcomes of epilepsy surgery

et al. 2018

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ObjectiveDespite 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.MethodsThis 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.ResultsWe 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.ConclusionThe 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.

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“…The success rate of epilepsy surgery is 40-60% and is influenced by multiple factors, e.g. location of the epileptic focus and pathology [18,19]. The aim of epilepsy surgery is to remove the epileptogenic zone (EZ), defined as the smallest area of cortex whose removal yields seizure freedom [20,21].…”

Section: Epilepsy Surgerymentioning

confidence: 99%

Computational modelling and electrical stimulation for epilepsy surgery

Hebbink¹

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Long-term outcomes of surgical treatment for epilepsy in adults with regard to seizures, antiepileptic drug treatment and employment

Cited by 71 publications

References 69 publications

NREM sleep is the state of vigilance that best identifies the epileptogenic zone in the interictal electroencephalogram

NREM sleep is the state of vigilance that best identifies the epileptogenic zone in the interictal electroencephalogram

The long-term outcomes of epilepsy surgery

Computational modelling and electrical stimulation for epilepsy surgery

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