Initial outcomes in the Multicenter Study of Epilepsy Surgery.
OBJECTIVE
To obtain prospective data regarding seizures, anxiety, depression, and quality of life (QOL) outcomes after resective epilepsy surgery.


METHODS
The authors characterized resective epilepsy surgery patients prospectively at yearly intervals for seizure outcome, QOL, anxiety, and depression, using standardized instruments and patient interviews.


RESULTS
Of 396 patients who underwent resective surgical procedures, 355 were followed for at least 1 year. Of these, 75% achieved a 1-year remission at some time during follow-up; patients with medial temporal (77%) were more likely than neocortical resections (56%) to achieve remission (p = 0.01). Relapse occurred in 59 (22%) patients who remitted, more often in medial temporal (24%) than neocortical (4%) resected patients (p = 0.02). QOL, anxiety, and depression all improved dramatically within 3 months after surgery (p < 0.0001), with no significant difference based on seizure outcome. After 3 months, QOL in seizure-free patients further improved gradually, and patients with seizures showed gradual declines. By 12 and 24 months, overall QOL and its epilepsy-targeted and physical health domains were significantly different in the two outcome groups. (Anxiety and depression scores also gradually diverged, with improvements in seizure-free and declines in continued seizure groups, but differences were not significant.)


CONCLUSIONS
Resective surgery for treatment of epilepsy significantly reduces seizures, most strikingly after medial temporal resection (77% 1 year remission) compared to neocortical resection (56% 1 year remission). Resective epilepsy surgery has a gradual but lasting effect on QOL, but minimal effects on anxiety and depression. Longer follow-up will be essential to determine ultimate seizure, QOL, and psychiatric outcomes of epilepsy surgery.
Spencer
S S
SS
Department of Neurology, Yale University School of Medicine, New Haven, CT 06520-8018, USA. susan.spencer@yale.edu
Berg
A T
AT
Vickrey
B G
BG
Sperling
M R
MR
Bazil
C W
CW
Shinnar
S
S
Langfitt
J T
JT
Walczak
T S
TS
Pacia
S V
SV
Ebrahimi
N
N
Frobish
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications / Q000175:diagnosis; D001921:Brain / Q000601:surgery; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000401:mortality; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012074:Remission Induction; D012640:Seizures / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D013702:Temporal Lobe / Q000601:surgery; D016896:Treatment Outcome