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Factors affecting seizure outcome after epilepsy surgery: an observational series

Bell, GS; De Tisi, J; Gonzalez-Fraile, JC; Peacock, JL; McEvoy, AM; Harkness, WFJ; Foong, J; ... Duncan, JS; + view all (2017) Factors affecting seizure outcome after epilepsy surgery: an observational series. Journal of Neurology, Neurosurgery and Psychiatry , 88 (11) pp. 933-940. 10.1136/jnnp-2017-316211. Green open access

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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 post-operative 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 post-surgery: MRI findings (eg hazard ratio adjusted for other variables in the model 2.5; 95% CI 1.6 to 3.8 for normal MRI compared with hippocampal sclerosis (HS)), 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 anti-epileptic drugs (1.05; 95% CI 1.01, 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 five 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.

Type: Article
Title: Factors affecting seizure outcome after epilepsy surgery: an observational series
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/jnnp-2017-316211
Publisher version: http://doi.org/10.1136/jnnp-2017-316211
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Epilepsy surgery, outcome, predictors, mesial temporal epilepsy, extratemporal epilepsy
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Experimental Epilepsy
URI: https://discovery.ucl.ac.uk/id/eprint/1572331
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