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Premature mortality in refractory partial epilepsy: does surgical treatment make a difference?
  1. G S Bell1,
  2. S Sinha1,
  3. J de Tisi1,
  4. C Stephani2,
  5. C A Scott1,
  6. W F Harkness1,
  7. A W McEvoy1,
  8. J L Peacock3,
  9. M C Walker1,
  10. S J Smith1,
  11. J S Duncan1,
  12. J W Sander1,4
  1. 1Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, UK
  2. 2Department of Clinical Neurophysiology, University of Göttingen, Göttingen, Germany
  3. 3University of Southampton School of Medicine, Southampton General Hospital, Southampton, UK
  4. 4SEIN, Epilepsy Institutes in the Netherlands Foundation, Heemstede, The Netherlands
  1. Correspondence to Professor Ley Sander, Box 29, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; lsander{at}ion.ucl.ac.uk

Abstract

Background Epilepsy carries an increased risk of premature death. For some people with intractable focal epilepsy, surgery offers hope for a seizure-free life. The authors aimed to see whether epilepsy surgery influenced mortality in people with intractable epilepsy.

Methods The authors audited survival status in two cohorts (those who had surgery and those who had presurgical assessment but did not have surgery).

Results There were 40 known deaths in the non-surgical group (3365 person years of follow-up) and 19 in the surgical group (3905 person-years of follow-up). Non-operated patients were 2.4 times (95% CI 1.4 to 4.2) as likely to die as those who had surgery. They were 4.5 times (95% CI 1.9 to 10.9) as likely to die a probable epilepsy-related death. In the surgical group, those with ongoing seizures 1 year after surgery were 4.0 (95% CI 1.2 to 13.7) times as likely to die as those who were seizure-free or who had only simple partial seizures. Time-dependent Cox analysis showed that the yearly outcome group did not significantly affect mortality (HR 1.3, 95% CI 0.9 to 1.8).

Conclusion Successful epilepsy surgery was associated with a reduced risk of premature mortality, compared with those with refractory focal epilepsy who did not have surgical treatment. To some extent, the reduced mortality is likely to be conferred by inducing freedom from seizures. It is not certain whether better survival is attributable only to surgery, as treatment decisions were not randomised, and there may be inherent differences between the groups.

  • Epilepsy
  • surgery
  • mortality

https://doi.org/10.1136/jnnp.2008.170837

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    Footnotes

    • Funding This work was carried out at University College London Hospitals/University College London, which received a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme. The study was partly supported by the UK National Society for Epilepsy. SS was supported by a Commonwealth Fellowship. JWS is supported by the Dr Marvin Weil Epilepsy Research Fund.

    • Competing interests None.

    • Ethics approval Ethics approval was provided by the Joint Ethics Committee of Institute of Neurology and National Hospital for Neurology.

    • Provenance and peer review Not commissioned; externally peer reviewed.