Assessment of the long-term effects of epilepsy surgery with three different reference groups.
OBJECTIVE
It is difficult to validly assess the long-term effect of epilepsy surgery. Here, this is attempted by comparing the outcome of surgically treated pharmacoresistant epilepsy patients to three different nonoperated comparison groups regarding seizure control, antiepilepsy drug (AED) usage, and health related quality of life (QOL).


METHODS
One hundred thirty-one operated patients (group 1, mean follow-up since presurgical assessment 6.9 years), 105 patients awaiting presurgical assessment (group 2, mean follow-up after assignment to waiting list 0.8 years), 99 patients considered to be presurgical candidates who chose to withdraw from waiting for presurgical assessment (group 3, mean follow-up after assignment to waiting list 5.5 years), and 49 patients who were not deemed to be eligible for surgery after comprehensive assessment (group 4, mean follow-up since presurgical assessment 6.5 years) were studied. The patients completed a questionnaire on seizures, AED usage, and QOL (ESI-55).


RESULTS
The surgical patients had a better outcome than all three comparison groups regarding seizure frequency, seizure freedom rate, and number of AEDs used. They scored higher than groups 2, 3, and 4 on 7/11, 6/11, and 3/11 ESI-55 domains, respectively.


CONCLUSIONS
The superior long-term outcome of the operated patients was most marked if compared to the patients awaiting surgery. This is compatible with the assumption that patients present for presurgical candidacy selection and assessment at a "nadir" of their disease course. After several years, a regression to the mean occurs which reduces (but does not abolish) the differences between nonoperated and operated patients.
Bien
Christian G
CG
University of Bonn, Department of Epileptology, Bonn, Germany. christian.bien@ukb.uni-bonn.de
Schulze-Bonhage
Andreas
A
Soeder
Bettina M
BM
Schramm
Johannes
J
Elger
Christian E
CE
Tiemeier
Henning
H
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D018572:Disease-Free Survival; D004351:Drug Resistance; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011300:Preoperative Care; D011788:Quality of Life; D016896:Treatment Outcome; D014850:Waiting Lists
D000927:Anticonvulsants