RT Journal Article
SR Electronic
T1 Factors affecting seizure outcome after epilepsy surgery: an observational series
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 933
OP 940
DO 10.1136/jnnp-2017-316211
VO 88
IS 11
A1 Gail S Bell
A1 Jane de Tisi
A1 Juan Carlos Gonzalez-Fraile
A1 Janet L Peacock
A1 Andrew W McEvoy
A1 William F J Harkness
A1 Jacqueline Foong
A1 Rebecca A Pope
A1 Beate Diehl
A1 Josemir W Sander
A1 John S Duncan
YR 2017
UL http://jnnp.bmj.com/content/88/11/933.abstract
AB Importance Surgical treatment can bring seizure remission in people with focal epilepsy but requires careful selection of candidates.Objectives To determine which preoperative factors are associated with postoperative seizure outcome.Design We audited seizure outcome of 693 adults who had resective epilepsy surgery between 1990 and 2010 and used survival analysis to detect preoperatively identifiable risk factors of poor seizure outcome.Results Seven factors were significantly associated with increased probability of recurrence of seizures with impaired awareness postsurgery: MRI findings (eg, HR adjusted for other variables in the model 2.5; 95% CI 1.6 to 3.8 for normal MRI compared with hippocampal sclerosis), a history of secondarily generalised convulsive seizures (2.3; 95% CI 1.7 to 3.0 for these seizures in the previous year vs never), psychiatric history (1.3; 95% CI 1.1 to 1.7), learning disability (1.8; 95% CI 1.2 to 2.6) and extratemporal (vs temporal) surgery (1.4; 95% CI 1.02, 2.04). People with an older onset of epilepsy had a higher probability of seizure recurrence (1.01; 95% CI 1.00, 1.02) as did those who had used more antiepileptic drugs (1.05; 95% CI 1.01 to 1.09). Combinations of variables associated with seizure recurrence gave overall low probabilities of 5-year seizure freedom (eg, a normal MRI and convulsive seizures in the previous year has a probability of seizure freedom at 5 years of approximately 0.19).Conclusions and relevance Readily identified clinical features and investigations are associated with reduced probability of good outcome and need consideration when planning presurgical evaluation.