The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study

Tisi, Jane de; Bell, Gail S.; Peacock, Janet L.; McEvoy, Andrew W.; Harkness, William; Sander, Josemir W.; Duncan, John S.

doi:10.1016/s0140-6736(11)60890-8

Cited by 733 publications

(638 citation statements)

References 26 publications

(31 reference statements)

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“…DNT are slowly growing WHO grade I tumors with a chance of malignant transformation of <1 % [8]. Similarly to GG, early surgical gross total resection represents the treatment of choice [9,[15][16][17][18]. Whether the presence of associated cortical dysplasia may influence the seizure outcome is still unclear [19,20].…”

Section: Clinical and Neuropathologic Featuresmentioning

confidence: 99%

Epilepsy Related to Developmental Tumors and Malformations of Cortical Development

Aronica

Crino

2014

Neurotherapeutics

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Section: Clinical and Neuropathologic Featuresmentioning

confidence: 99%

Epilepsy Related to Developmental Tumors and Malformations of Cortical Development

Aronica

Crino

2014

Neurotherapeutics

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“…Resective epilepsy surgery is far from a cure: 30–40% of patients undergoing a resection for frontal lobe epilepsy (FLE) are seizure free a decade after surgery,43, 44 whereas only 50–60% remain seizure free 10 years after TLE surgery 43, 45, 46. Seizure recurrence is a complex, multifactorial, and dynamic phenomenon.…”

Section: Surgical Outcomesmentioning

confidence: 99%

Not all that glitters is gold: A guide to surgical trials in epilepsy

Jehi

2016

Epilepsia Open

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SummaryEpilepsy surgery is often the only effective treatment in appropriately selected patients with drug‐resistant epilepsy, a disease affecting about 30% of those with epilepsy. We review the evidence supporting the use of epilepsy surgery, with a focus on randomized controlled trials (RCTs). Second, we identify gaps in knowledge about the benefits of epilepsy surgery for certain populations, the challenges of individualizing the choice of surgery, and our lack of understanding of the mechanisms of surgical outcomes. We conducted a search (MEDLINE, Embase, Cochrane, Clinicaltrials.gov) on March 2, 2016, to identify epilepsy surgery RCTs, systematic reviews, or health technology assessments (HTAs). Abstracts were screened to identify resective, palliative (e.g., corpus callosotomy, multiple subpial transection [MST]), ablative (e.g., Laser interstitial thermal therapy [LITT], gamma knife radiosurgery [RS]), and neuromodulation (e.g., cerebellar stimulation [CS], hippocampal stimulation [HS], repetitive transcranial magnetic stimulation [rTMS], responsive neurostimulation [RNS], thalamic stimulation [TS], trigeminal nerve stimulation [TNS], and vagal nerve stimulation [VNS]) RCTs. Study characteristics and outcomes were extracted. Knowledge gaps were identified. Of 1,205 abstracts, 20 RCTs were identified (resective surgery including corpus callosotomy [n = 7], MST [n = 0], RS [n = 1, 3 papers], LITT [n = 0], CS [n = 1], HS [n = 2], RNS [n = 1], rTMS [n = 1], TNS [n = 1], TS [n = 1], and VNS [n = 5]). Most studies targeted patients with temporal lobe epilepsy (TLE) and none examined the effectiveness of resective surgical therapies in patients with extra‐TLE (ETLE) or with specific lesions aside from mesial temporal lobe sclerosis. No pediatric surgical RCTs were identified except for VNS. Few RCTs address the effectiveness of surgery in epilepsy and most are of limited generalizability. Future studies are needed to compare the effectiveness of different surgical strategies, better understand the mechanisms of surgical outcomes, and define the ideal surgical approaches, particularly for patients with high or very low cognitive function, normal imaging, or ETLE.

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“…Epilepsy surgery is an effective and safe alternative form of therapy for those patients with focal onset epilepsy [32,[42][43][44][45][46][47][48][49][50][51]. Major complications from epilepsy surgery and subdural electrode evaluation have an incidence of less than 7% and long term permanent deficits have an incidence of less than 2% [52][53][54][55][56][57][58].…”

Section: Non-pharmacological Treatmentmentioning

confidence: 99%

Review of Epilepsy - Etiology, Diagnostic Evaluation and Treatment

Shin¹,

Jewells²,

Hadar³

et al. 2014

Int J Neurorehabilitation Eng

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Epilepsy is the fourth most common neurological disorder in the US, affecting nearly 2.5 million Americans. The economic impact of epilepsy represents estimated direct and indirect costs of 12.5 billion dollars per year. Patients with this disorder experience increased morbidity and mortality with long term fatality rates of 24%. Multiple diagnostic tools are used to identify and classify the seizure type/syndrome, etiology and localization of seizures, including electroencephalogram (EEG), magnetic resonance imaging (MRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT), magneto encephalogram (MEG), and neuropsychiatric testing. Despite 29 different antiepileptic medications that are available in the US, one third of patients remain refractory to pharmacological treatment. In these intractable epilepsy patients, non-pharmacological treatments can be considered. Commonly used non-pharmacological treatment options for epilepsy include epilepsy surgery, neurostimulation therapy, and diet therapy. Review of Epilepsy -Etiology, Diagnostic Evaluation and Treatment

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The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study

Abstract: UK Department of Health National Institute for Health Research (NIHR) Biomedical Research Centres funding scheme, Epilepsy Society, Dr Marvin Weil Epilepsy Research Fund.

Cited by 733 publications

References 26 publications

Epilepsy Related to Developmental Tumors and Malformations of Cortical Development

Epilepsy Related to Developmental Tumors and Malformations of Cortical Development

Not all that glitters is gold: A guide to surgical trials in epilepsy

Review of Epilepsy - Etiology, Diagnostic Evaluation and Treatment

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