Prognosis after late relapse following epilepsy surgery.
OBJECTIVE
To assess prognosis after late relapse in patients who are seizure free for the first 5 years after epilepsy surgery.


METHODS
Patients who were seizure free for the first 5 years after resective epilepsy surgery were included. Date of first seizure recurrence, current seizure status, medication, age, and type of surgery were prospectively registered. Non-parametric statistics were used.


RESULTS
One hundred and fifty-nine patients were studied. Thirty-two had at least one recurrent seizure. Time to event analysis showed an annual relapse rate of 4% between years 5 and 10 after surgery. At study termination, 143 of 159 patients (89.9%) were in terminal remission. For 30 patients with late relapse and at least 1-year follow-up thereafter, 53% were in terminal remission and 30% had experienced only rare or nocturnal seizures. Medication use was not associated either with likelihood of relapse or entering remission after relapse.


CONCLUSIONS
Patients who are seizure free for the first 5 years after epilepsy surgery remain at risk for seizure recurrence. These relapses are often isolated events, and the long-term prognosis after relapse is often good. Relapse rates were similar in patients on and off AEDs, but the relation between AED taper and relapse is uncertain since patient groups may not be similar.
Sperling
Michael R
MR
Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, United States. michael.sperling@jefferson.edu
Nei
Maromi
M
Zangaladze
Andro
A
Sharan
Ashwini D
AD
Mintzer
Scott E
SE
Skidmore
Christopher
C
Evans
James G
JG
Schilling
Courtney A
CA
Asadi-Pooya
Ali A
AA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D004827:Epilepsy / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D055502:Secondary Prevention; D016896:Treatment Outcome
D000927:Anticonvulsants