title: The Irish epilepsy surgery experience: Long-term follow-up.
abstract: OBJECTIVE
  To assess the long-term seizure outcome of Irish patients who underwent resective surgery for refractory epilepsy since 1975. We also wished to determine the impact of pathology and surgical technique (with particular reference to neocorticectomy) on seizure outcome.
  
  
  METHODS
  A retrospective review of medical notes, radiological and histopathological records, was undertaken between 1975 and 2005. Missing data was supplemented by telephone calls to patients. One hundred and ninety-nine patients suited the criteria for inclusion and had at least 1-year follow-up (1-24 years, mean 7.0 years). Engel's criteria were used to classify seizure outcome at 1, 2, 5, 10, 15 and >15 years follow-up.
  
  
  RESULTS
  The percentage of patients seizure free at 2, 5, 10, 15 and >15 years were, 56.6%, 41.4%, 44%, 25% and 31.3%, respectively. Of patients with a pathologically confirmed diagnosis of mesial temporal sclerosis, 55.6% were seizure free at 10 years. Equivalent figures for tumour were 62.5%, for cortical dysplasia, 34.8%, for those without any demonstrable pathologic abnormality, 50%, for dual pathology, 50% and for all others, 33.3%. Of those with 10 years or greater follow-up only 20% of neocorticectomy patients were in Engel class 1, compared with an average of 58.5% for the other surgical techniques.
  
  
  CONCLUSIONS
  Seizure freedom rates for Irish Patients were comparable to other large retrospective studies. Patients who underwent selective procedures tended to do better than those undergoing lobar resections, in keeping with international trends. The surgical technique unique to the Irish cohort, temporal necocorticectomy, had the worst long-term outcome.
authors.affiliation: Department of Neurology, Beaumont Hospital, Dublin 9, Ireland. odunlea@hotmail.com
authors.forename: Orla
authors.initials: O
authors.lastname: Dunlea
authors.forename: Colin P
authors.initials: CP
authors.lastname: Doherty
authors.forename: Michael
authors.initials: M
authors.lastname: Farrell
authors.forename: Mary
authors.initials: M
authors.lastname: Fitzsimons
authors.forename: Donncha
authors.initials: D
authors.lastname: O'Brien
authors.forename: Kevin
authors.initials: K
authors.lastname: Murphy
authors.forename: Deirdre
authors.initials: D
authors.lastname: MacMackin
authors.forename: Niall
authors.initials: N
authors.lastname: Pender
authors.forename: Hugh
authors.initials: H
authors.lastname: Staunton
authors.forename: Jack
authors.initials: J
authors.lastname: Phillips
authors.forename: Norman
authors.initials: N
authors.lastname: Delanty
mesh_terms: D000293:Adolescent; D000328:Adult; D038481:Anterior Temporal Lobectomy; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007494:Ireland; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012640:Seizures / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult