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Factors affecting seizure outcome after epilepsy surgery: an observational series

Research output: Contribution to journalArticle

Gail S Bell ; Jane de Tisi ; Juan Carlos Gonzalez-Fraile ; Janet L Peacock ; Andrew W McEvoy ; William F J Harkness ; Jacqueline Foong ; Rebecca A Pope ; Beate Diehl ; Josemir W Sander ; John S Duncan

Original languageEnglish
Pages (from-to)933-940
JournalJournal of neurology, neurosurgery, and psychiatry
Early online date4 Sep 2017
DOIs
StatePublished - Nov 2017

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Abstract

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.

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