Surgical outcomes in patients with epileptogenic tumours and cavernomas in Sweden: good seizure control but late referrals
- 1Epilepsy Research Group, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden
- 2Department of Clinical Neurophysiology, Akademiska University Hospital, Uppsala, Sweden
- Correspondence to Professor B Rydenhag, Epilepsy Research Group, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg University, Per Dubbsgatan 14, 1 tr, SE 413 45 Göteborg, Sweden;
Contributors The study was drafted by BR and KM, who also analysed and interpreted the data. All authors contributed to the study design, conceptualisation and intellectual content.
- Received 6 February 2012
- Revised 15 June 2012
- Accepted 7 August 2012
- Published Online First 5 September 2012
Purpose Seizure outcome after epilepsy surgery is to an important extent related to underlying aetiology. In this study of patients who underwent epilepsy surgery with a lesional aetiology in Sweden 1990–2004, the aim was to investigate seizure outcome and prognostic factors.
Methods All patients operated on during the time period with a histopathological diagnosis of an epileptogenic tumour (ganglioglioma (GGL), dysembryoblastic neuroepithelial tumour (DNET) and low grade astrocytoma (AST)) or a cavernous haemangioma (CAH) were identified in the population based Swedish National Epilepsy Surgery Register. Univariate and multivariate analyses were performed to determine the independent contribution of the following variables to seizure outcome: age at surgery; epilepsy duration; preoperative seizure frequency; localisation of the resection; and histopathology.
Results Of the 156 identified patients who had a 2 year follow-up (103 adults and 53 children), 71% had temporal, 16% frontal and 13% parietal and occipital lobe resections. Mean presurgical epilepsy duration was 13 years in adults and 5 years in children. Main histopathological diagnosis was GGL or DNET in 67, CAH in 42 and AST in 47 patients. 77% of patients had sustained seizure freedom (with or without aura) 2 years after surgery. In the multivariate analysis, only diagnosis other than AST was independently associated with becoming seizure free.
Conclusion In this population based series, 120/156 patients (77%) with epileptogenic tumours and cavernomas were seizure free 2 years after surgery. Many had a very long epilepsy history. Seizure outcome can be improved if epilepsy surgery is considered earlier in patients with epileptogenic lesions.
Funding The study was funded by the Sahlgrenska Academy at Gothenburg University through the LUA/ALF agreement grant ALFGBG137431, and from the Swedish Research Council grant 521-2011-169.
Competing interests None.
Ethics approval All patients whose data are included in the register have given their informed consent. For studies which are solely based on group data from patient files or on registers containing only data from patient files, ethics committee permission is not requested in Sweden.
Provenance and peer review Not commissioned; externally peer reviewed.