Multivariate analysis of seizure outcomes after resective surgery for focal epilepsy: a single-center study on 833 patients

Abstract

The predictors of long-term seizure outcomes after resectivesurgery for focal epilepsy, for an update on the features of good and poor outcomes is investigated. A retrospective study of patients with focal epilepsy undergoing resectivesurgery from March 2011 toApril 2019 was performed. There were 3 groups according to the seizure outcomes: group A, seizure freedom; group B, seizure improvement; group C, no improvement. Five comparisons were performed: comparison 1, A vs. B and C; comparison 2, A vs. B; comparison 3, A vs. C; comparison 4, B vs. C; comparison 5, A and B vs. C. Predictors of seizure outcomes were identi ed by multivariate logistic regression analysis. Of all 833 patients, 561 (67.3%) patients remained seizure-free at the last follow-up, 203 (24.4%) patients had seizure improvement, and 69 (8.3%) had no improvement. The mean follow-up duration was 5.2 years (range: 2.7 to 9.6). Predictors of better outcomes included epilepsyduration <5 years (comparisons 1-3), localized discharge (comparisons 1 and 2), no. of antiepileptic drugs at surgery <3 (comparison 5), and temporal lobe resection (comparisons 1 and 3). However, predictors of worse outcomes included intracranial haemorrhage in infancy (comparisons 1 and 2), interictal abnormal discharge (comparisons 1 and 2), intracranial electrode monitoring (comparisons 1 and 2), and acute postoperative seizure (all comparisons). Our study suggests that resectivesurgery for focal epilepsy has satisfactory outcomes. Short epilepsy duration, localized discharge, and temporal lobe resection are positive predictors of seizure freedom. Patients with these predictors are intensivelyrecommended for surgery.