November 7, 2022

Beyond Seizure-Freedom: Dissecting Long-Term Seizure Control after Surgical Resection for Drug Resistant Epilepsy

Abstract found on PubMed 

Objective: To better understand the long-term palliative and disease-modifying effects of surgical resection beyond seizure-freedom, including frequency reduction and both late recurrence and remission, in patients with drug-resistant epilepsy.

Methods: Retrospective database-driven cohort study of all patients with > 9 years follow-up at a single high-volume epilepsy center. We included patients who underwent lobectomy, multilobar resection, or lesionectomies for drug-resistant epilepsy; we excluded patients who underwent hemispherectomies. Our main outcomes were: 1. Reduction in frequency of disabling seizures (at 6 months, each year up to 9 years postoperatively, and at last follow-up). 2. Achievement of seizure remission (>6 months, >1 year, and longest duration). 3. Seizure freedom at last follow-up.

Results: We included 251 patients; 234 (93.2%) achieved 6 months, and 232 (92.4%) experienced 1 year of seizure freedom. Of these, the average period of seizure freedom was 10.3 years. 182 (72.5%) patients were seizure-free at last follow-up (defined as > 1 year without seizures), with a median 11.9 years since remission. For patients not completely seizure-free, the mean seizure frequency reduction at each timepoint was 76.2%, and ranged from 66.6% to 85.0%. Patients decreased their number of antiseizure medications on average by 0.58, and 53 (21.2%) patients were on no antiseizure medication at last follow-up. Nearly half (47.1%) of those seizure-free at last follow-up were not seizure-free immediately postoperatively.

Significance: Patients who continue to have seizures after resection often have considerable reductions in seizure frequency, and many are able to achieve seizure freedom in a delayed manner.

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