Abstract
Objective: To describe long-term seizure remission and relapse patterns, psychiatric comorbidity, and socioeconomic outcomes following frontal lobe epilepsy surgery.
Methods: We reviewed data on frontal lobe epilepsy procedures at the National Hospital for Neurology & Surgery, UK, between 1990 and 2020. This included the presurgical evaluation, operative details and annual postoperative seizure and psychiatric outcomes, prospectively recorded in an epilepsy surgery database. Outcome predictors were subjected to multivariable analysis, and rates of seizure freedom analysed using Kaplan-Meier methods. We used longitudinal assessment of the Index of Multiple Deprivation to assess change in socioeconomic status over time.
Results: A total of 122 individuals with a median follow-up of seven years were included. Of these, 33 (27%) had complete seizure freedom following surgery, with a further 13 (11%) having only auras. Focal MRI abnormality, a focal lesion on histology (focal cortical dysplasia, cavernoma or dysembryoplastic neuronal epithelial tumour) and fewer anti-seizure medications at time of surgery were predictive of favourable outcome; 67% of those seizure-free for the first 12 months postoperatively never experienced seizure relapse. Thirty-one of 50 who had preoperative psychiatric pathology noticed improved psychiatric symptomatology by two years postoperatively. New psychiatric comorbidity was diagnosed in 15 (13%). Persistent motor complications occurred in 5% and dysphasia in 2%. No significant change in socioeconomic deciles of deprivation was observed after surgery.
Conclusion: Favourable long-term seizure, psychiatric and socioeconomic outcomes can be seen following frontal lobe epilepsy surgery. This is a safe and effective treatment that should be offered to suitable individuals early.
Methods: We reviewed data on frontal lobe epilepsy procedures at the National Hospital for Neurology & Surgery, UK, between 1990 and 2020. This included the presurgical evaluation, operative details and annual postoperative seizure and psychiatric outcomes, prospectively recorded in an epilepsy surgery database. Outcome predictors were subjected to multivariable analysis, and rates of seizure freedom analysed using Kaplan-Meier methods. We used longitudinal assessment of the Index of Multiple Deprivation to assess change in socioeconomic status over time.
Results: A total of 122 individuals with a median follow-up of seven years were included. Of these, 33 (27%) had complete seizure freedom following surgery, with a further 13 (11%) having only auras. Focal MRI abnormality, a focal lesion on histology (focal cortical dysplasia, cavernoma or dysembryoplastic neuronal epithelial tumour) and fewer anti-seizure medications at time of surgery were predictive of favourable outcome; 67% of those seizure-free for the first 12 months postoperatively never experienced seizure relapse. Thirty-one of 50 who had preoperative psychiatric pathology noticed improved psychiatric symptomatology by two years postoperatively. New psychiatric comorbidity was diagnosed in 15 (13%). Persistent motor complications occurred in 5% and dysphasia in 2%. No significant change in socioeconomic deciles of deprivation was observed after surgery.
Conclusion: Favourable long-term seizure, psychiatric and socioeconomic outcomes can be seen following frontal lobe epilepsy surgery. This is a safe and effective treatment that should be offered to suitable individuals early.
| Original language | English |
|---|---|
| Article number | 2247 |
| Pages (from-to) | A2 |
| Number of pages | 1 |
| Journal | BMJ Neurology Open |
| Volume | 4 |
| Issue number | Suppl 1 |
| DOIs | |
| Publication status | Published - Aug 2022 |
| Externally published | Yes |
| Event | Australian & New Zealand Association of Neurologists (ANZAN) Annual Scientific Meeting 2022 - Melbourne Convention & Exhibition Centre, Melbourne, Australia Duration: 10 May 2022 → 13 May 2022 https://anzheadachesociety.org/event/2022-australian-new-zealand-association-of-neurologists-anzan-annual-scientific-meeting/ |
Keywords
- epilepsy
- surgery
- frontal lobe epilepsy surgery