Abstract
Epilepsy surgery is an efficacious treatment for selected persons with drug-resistant focal epilepsy, rendering many seizure-free and others significantly improved. There is Class I evidence for short-term efficacy of epilepsy surgery from two randomized controlled studies of temporal lobe resection. In order for patients to make an informed decision about the treatment option of epilepsy surgery, they also need data on the probability of long-term remission or improvement. Long-term longitudinal observational studies are necessary in order to obtain valid outcome data. From a number of such studies, the proportion of patients who have been continuously free from seizures with impairment of consciousness since resective surgery seems to be 40–50 % after 10 years, while a higher proportion have been seizure-free at least a year at each time-point assessed. The best longitudinal data are in patients who have undergone temporal lobe resection and in whom the histopathology was mesial sclerosis, and in these patients the majority of relapses occur within 5 years. Whether this course is applicable to other resection types and pathologies is not clear. There is much less information on the longitudinal course in patients who have undergone other resection types and have other causes. For many resection types, the number of patients in single-center long-term follow-ups is limited and for almost all studies there is a lack of controls. Multicenter observational studies following both operated and nonoperated patients are needed in order to obtain more robust data.
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Appendix. Summary of Study Characteristics and Results from Long-Term Studies of Seizure Outcome in Adults
Appendix. Summary of Study Characteristics and Results from Long-Term Studies of Seizure Outcome in Adults
Author, year | Study design | Type of surgery | Pathology | Operated patients N | Dropouts N | Number in study group | Follow-up, years mean (min-max) | Males % | Age at surgery mean (min-max) | Prognostic indicators studied | Outcome measures | Good outcome | Statistical methods |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Asztely, 2007 | P S X | RES T + XT | All | 70 | 5 | 65 | 12.4 (8.6–16.2) | 51 | 35 (19–58) | None | ILAE 1&2 | 58 % ILAE 1&2 | MW |
Aull-Watschinger, 2008 | P S L | RES T | HS | 135 | 3 | 72 at 5 years | 5 | 45 | 35 (15–52) | A B D E G | ILAE 1&2 | 46 % ILAE 1a, 79 % ILAE 1&2 | LogReg |
Bien, 2001 | R S X | RES T | All | NS | NS | 148 | 4.8 (2–10) | 45 | 31.5 (9–64) | None | Engel I, ILAE 1 | 44 % Engel IA, 62 % ILAE 1 | MW |
Bien, 2006 | R S X | RES T + XT | All | 175 identified | 44 | 131 | 6.9 (SD 2.7) | 53 | 31.1 (SD 10.6) | None | Not defined | 52 % seizure-free last year | t-test, Ch, MW, ANCOVA |
Bien, 2012 | R S X | RES T + XT | All | 1,721 | NS | 1,160 | 5.4 (2–20.5) | 52 | 31 (0–74) | None | Engel IA, ILAE 1 | 50 % Engel IA, 63 % ILAE 1 | MW |
Cohen-Gadol, 2006 | R S X + L | RES T + XT | Non-lesional (incl HS) | 399 | 14 | 156 at 5 years 73 at 10 years | 6.2 (0.6-15.7) | 46 | 32 (3–69) | A D G H Histopathology, sex, lobe, previous surgery* (unclear if multivariate analysis) | Engel I | 74 % at 5 years 72 % at 10 years | KM, CPH |
de Tisi, 2011 | R S L | All | All | 649 | 34 | 615; 234 at 5 years 122 at 10 years | 8 (1–19) | 47 | (16–63) | A D G H Age, type of surgery, histopathology, postop auras | ILAE 1&2, sustained seizure freedom | Sust SF incl aura: 52 % at 5 years, 47 % at 10 years. 68–73 % ILAE 1&2 at each year | KM, CPH |
Di Gennaro, 2014 | R S X + L | RES T | HS | 113 identified | 6 | 107 | 8.3 (5–12) | 61 | 35 (11–62) | A C D E Postop IED* | Engel IA, ILAE 1 | 62 % Engel IA, 81 % ILAE 1 | LR, Ch, LogReg |
Dunlea, 2010 | R N X + L | RES T + XT | All | 329 identified | 130 | 199 | 7 (1–24) | 48 | 26.3 (1–61) | None | Engel I (not consistent) | 43 % Engel I after mean 7 years. 41 % SF at 5 years, 44 % at 10 years, 25 % at 15 years | NS |
Dupont, 2006 | R S X | RES T | HS | 183 | 73 | 110 | 7 (1–17) | 51 | 35 (SD 10) | None | Engel | 43 % Engel IA, 71 % Engel I after mean 7 years. KM-estimates: Engel IA 59 % at 5 years, 43 % at 10 years | Ch, Fi, KM |
Edelvik, 2013 | P N X + L | RES T + XT | All | 219 | 29 | 190 | 7.6 (5 and 10 years) | 46 | 37.7 (19–67) | A D F G H Duration, seizure frequency, MRI | ILAE 1&2 | 41 % sust SF incl aura, 62 % ILAE 1&2 at mean 7 years | Ch, Fi, LogReg |
Elsharkawy, 2008 | R S X + L | RES F | All | 134 | 37 | 97; 66 at 5 years 31 at 10 years | 6.9 (2–14) | 59 | 28.5 (16–69) | A D E F G MRI lesion, postop aura* | Engel IA, Engel I | 35 % Engel IA and 47 % Engel I at 5 years. 35 % Engel IA and 42 % Engel I at 10 years | KM, CPH, LogReg |
Elsharkawy, 2008 [2] | R S X + L | RES XT | All | NS | NS | 154 | 8.8 (1–14) | 59 | ~29 (16–59) | A B D E G invasive EEG, single operation, early surgery, auditory aura*, GTCS* (only univariate testing) | Engel I | 52 % at 5 and 10 years | KM, CPH |
Elsharkawy, 2009 | R S X + L | RES T | All | 483 | 49 | 434; 419 at 5 years 366 at 10 years 147 at 16 years | NS (0.5–16) | 51 | NS | A D E F H hippocampal atrophy, family history of ep, bilateral IED*, versive seizures* | Engel I | 71 % at 5 years 71 % at 10 years 69 % at 16 years | KM, CPH, LogReg |
Ferrier, 1999 | R S X | RES F | All | 42 | 5 | 37 | 5.9 (1–19) | 49 | 16.8 (1–38) | A B D E F β Contralateral head version*, MRI lesion | Engel I | 32 % Engel I | MW, Ch, Fi, LogReg |
Foldvary, 2000 | R S X | RES T | All | NS | 17 | 79 | 14 (2–34) | 57 | 24 (SD 9) | A B D G Seizure frequency (only univariate testing) | Engel I | 35 % Engel IA and 65 % Engel I at mean 14 years. 52 % Engel I at 5 years, 45 % at 10 years | KM, logrank |
Hanakova, 2014 | R S L | RES XT | All | 77 | 4 | 73 | 6 (1–15) | 63 | 28.3 (1–51) | A F H MRI, histopathology (only univariate testing) | Engel I | 51 % Engel I after mean 6 years. 55 % Engel I at 5 years | ANOVA, Ch, KM |
Jeha, 2006 | R S X | RES T | All | 497 | 126 | 371 | 5.5 (1–14) | NS | NS, “adults” | A D E F G H ECoG, histopathology (only univariate testing) | Not defined | Seizure relapse in 37 % | Multiphase hazard modeling |
Jeha, 2007 | R S X | RES F | All | NS | NS | 70; 22 at 5 years | 4.1 (1–11) | 57 | 22 (1–57) | A B D E F G H Predictors for recurrence: MRI-negativity, extrafrontal MRI-finding, non-localizing EEG, APOS, incomplete resection | Engel | 44 % Engel IA + B after mean 4 years. KM-estimate: 27 % at 5 years (6/22) | W, Ch, Fi, CPH, KM |
Jobst, 2000 | R S X | RES F | All | 25 identified | 0 | 25 | 4.3 (1–7) | 58 | 27 (11–44) | None | Engel I | 64 % Engel I | NS |
Kelley, 2005 | R S X | RES T | All | 56 identified | 11 | 45 | 29.9 (SD 4.9) | NS | NS | A C E G Seizures first postop year*, invasive EEG* | SF last 20 years | 50 % SF 30 years after surgery | Ch, KM, LogReg |
Kim, 2010 | R S X | RES F | All | NS | NS | 76 | 6.8 (SD 2.9) | 62 | 28.5 (SD 9.3) | A B C D E F G H K MRI | Engel I | 55 % Engel I | MW, Ch KM, CPH |
Lazow, 2012 | R S X | RES F | All | 58 identified | 0 | 58 | 6.6 (1–17) | 55 | 30 (9–58) | C E F H K | Engel, ILAE | 24 % Engel IA 57 % Engel I 50 % ILAE | Ch, Fi, LogReg, KM |
Luyken, 2003 | R S X + L | RES T + XT | Tumors | 214 | 7 | 207 | 8 (2–14) | 50 | 28 (5–67) | A B D E G H Duration, unifocal EEG, type of tumor, dual pathology*, extent of resection, surgical approach | Engel I | 81 % Engel I at 5 years, 81 % Engel I at 10 years | Ch, Fi, KM, MW, LogReg |
McIntosh, 2004 | R S X + L | RES T | All | 360 | 35 | 325 138 at 5 years 56 at 10 years | 9.6 (0.7–23) | NS | NS (6.7–59) | A D H K Histopathology, GTCS* | Engel IA + B + D | 48 % SF at 5 years 41 % SF at 10 years | Ch, Fi, LogReg, KM |
McIntosh, 2012 | R S X + L | RES XT | All | 87 | 6 | 81 | 10.3 (1–17.7) | 47 | 27.5 (4–60) | A D E G H Histopathology, early seizures* | Engel IA + B, ILAE 1&2 | At 5 years: Engel IA + B 14 %, ILAE 1&2 38 % | KM, CPH |
Menon, 2012 | R SX | RES XT | All | NS | NS | 106 | 4.6 (2–11) | 69 | 19.7 (3–45) | A D E G H Duration, postop IED* | Engel IA, ILAE 1 | 38 % Engel IA 59 % ILAE 1 | MW, Ch, Fi, KM, LogReg |
Mihara, 2004 | R S X | RES T + XT | All | 488 | 131 | 282 T 75 XT | 6 (2–16) T 5 (2–13) XT | NS | ~24 (2–55) | None | Engel I | 78 % Engel I (T) 64 % Engel I (XT) | None |
Mohammed, 2012 | R S X | All | All | 361 | 244 | 117 | 26.5 (21–42) | 62 | 20 (2–51) | A B D G H | Engel I | 48 % Engel I | Ch, Fi |
Mosewich, 2000 | R S X | RES F | All | 68 | 0 | 68 | ~4.0 (SD 2.5) | 66 | 30.1 (4–51) | A C D E F G MRI, febrile seizures*, (only univariate testing) | SF or nondisabling seizures | 59 % “excellent outcome” (not completely SF) | Ch, Fi, W, LogReg |
Mu, 2014 | R S X | RES F | All | NS | NS | 46 | 5.0 (0.5–17) | 61 | 30.4 (10–58) | A B G K Monofocal MEG, side | Engel IA | 48 % Engel IA | W, Ch, Fi, KM, CPH |
Murphy, 2010 | R S X | RES T | HS | 21 | 0 | 21 | 9.5 (SD 2.4) | 33 | 54.9 (50–72) | A B C F G | “Modified” Engel | 81 % Engel I | Fi, MW, LogReg |
Paglioli, 2004 | P S L | RES T | HS | 135 | 1 | 134; 69 at 5 years | 5.5 (2–11) | NS | 31.6 (8–62) | A E F G H | Engel I | At 5 years: 91 % Engel I 75 % Engel IA | KM, Ch, Fi |
Paillas, 1983 | R S X | All | All | NS | NS | 44 | NS (11–26) | NS | NS | None | NS | Study of patients who have been SF beyond 10 years. 32/44 (73 %) continued SF up to 26 years after surgery | None |
Park, 2010 | R S X | RES neocortical | All | 283 identified | 60 | 223 | 7 (2–12) | NS | NS | NS | NS | 54 % SF | Ch, Fi, CPH, KM |
Phi, 2009 | R S X + L | RES T | Tumors | 87 identified | 0 | 87 | 4.5 (1–10.7) | 56 | 22 | A B D E G H Duration, non-concordant EEG*, extent of resection | NS | 79 % SF at 5 years | KM, CPH |
Ramesha, 2011 | R S L | RES T | All | 513 | 21 | 492 | 5.2 (2–11) | 56 | 29 (1–60) | A B D G H Early relapse*, seizure type at relapse (CPS/GTCS)* | ILAE 1 | If no relapse during first year, 90 % SF at 5 years; if relapse during first year, 63 % SF at 5 years | Fi, KM, CPH |
Rathore, 2011 | R S L | RES T | HS, non-lesional | 327 | 17 | 310 | 8.0 (SD 2.0) | 55 | 27.1 (SD 9.2) | A D E F H HS, postop IED* | ILAE | 82 % ILAE 1 45 % ILAE 1a | KM, Fi, Ch, LogReg |
Schwartz, 2006 | R M X + L | All | All but vascular and neocortical tumors | NS | NS | 285 with 1 year seizure freedom | 7.9 (SD 3.1) | NS | 33.4 (SD 9.6) | A D E G H K Age, GTCS* | Not defined | After 1 year of seizure freedom 28 % will relapse; Risk estimation: 18 % after 5 years, 33 % after 10 years | KM, CPH |
Spencer, 2005 | P M X + L | RES T + XT | All | 396 | 57 | 339 | 4.6 (2–7) | NS | NS, over age 12 | A B C D E F G H GTCS*, HS | SF ≥ 2 years incl aura | 66 % SF at mean 4.6 years. 69 % SF at 5 years | Ch, CPH, KM |
Sperling, 1996 | R S L | RES T | All | 93 | 4 | 89 | 5 | 51 | 32 (10–60) | A D E K No multivariate analysis | SF last year incl aura | 70 % SF at 5 years | Ch, Fi, t-test, ANOVA |
Tanriverdi, 2008 | R S L | RES T | All | 63 | 15 | 48 | 12 | 49 | 34 (SD 11) | None | Engel IA | 71 % Engel IA at 12 years | MW, Ch |
Vickrey, 1995 | R S X | RES T + XT | All | 202 | 5 | 197 | 5.8 | 48 | 27.0 | None | ILAE 1 | 31 % ILAE 1 | t-test, Ch, Fi, W, MW |
Wieser, 2003 | R S L | RES SelAH | HS, lesions | 464 | 95 | 369 234 at 5 years 125 at 10 years | 7.2 (1–24) | 58 | ~32 (SD ~12) | None | Engel ILAE (only in diagrams) | ~65 % Engel I, ~55 % ILAE 1 at 5 and 10 years; ILAE 1a: ~38 % at 5 and ~34 % at 10 years | Fi, MW |
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Malmgren, K., Edelvik, A., Duncan, J.S. (2015). Long-Term Seizure and Antiepileptic Drug Outcomes After Epilepsy Surgery in Adults. In: Malmgren, K., Baxendale, S., Cross, J. (eds) Long-Term Outcomes of Epilepsy Surgery in Adults and Children. Springer, Cham. https://doi.org/10.1007/978-3-319-17783-0_3
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