title: Premature mortality in refractory partial epilepsy: does surgical treatment make a difference?
abstract: BACKGROUND
  Epilepsy carries an increased risk of premature death. For some people with intractable focal epilepsy, surgery offers hope for a seizure-free life. The authors aimed to see whether epilepsy surgery influenced mortality in people with intractable epilepsy.
  
  
  METHODS
  The authors audited survival status in two cohorts (those who had surgery and those who had presurgical assessment but did not have surgery).
  
  
  RESULTS
  There were 40 known deaths in the non-surgical group (3365 person years of follow-up) and 19 in the surgical group (3905 person-years of follow-up). Non-operated patients were 2.4 times (95% CI 1.4 to 4.2) as likely to die as those who had surgery. They were 4.5 times (95% CI 1.9 to 10.9) as likely to die a probable epilepsy-related death. In the surgical group, those with ongoing seizures 1 year after surgery were 4.0 (95% CI 1.2 to 13.7) times as likely to die as those who were seizure-free or who had only simple partial seizures. Time-dependent Cox analysis showed that the yearly outcome group did not significantly affect mortality (HR 1.3, 95% CI 0.9 to 1.8).
  
  
  CONCLUSIONS
  Successful epilepsy surgery was associated with a reduced risk of premature mortality, compared with those with refractory focal epilepsy who did not have surgical treatment. To some extent, the reduced mortality is likely to be conferred by inducing freedom from seizures. It is not certain whether better survival is attributable only to surgery, as treatment decisions were not randomised, and there may be inherent differences between the groups.
authors.affiliation: Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, UK.
authors.forename: G S
authors.initials: GS
authors.lastname: Bell
authors.forename: S
authors.initials: S
authors.lastname: Sinha
authors.forename: J de
authors.initials: Jd
authors.lastname: Tisi
authors.forename: C
authors.initials: C
authors.lastname: Stephani
authors.forename: C A
authors.initials: CA
authors.lastname: Scott
authors.forename: W F
authors.initials: WF
authors.lastname: Harkness
authors.forename: A W
authors.initials: AW
authors.lastname: McEvoy
authors.forename: J L
authors.initials: JL
authors.lastname: Peacock
authors.forename: M C
authors.initials: MC
authors.lastname: Walker
authors.forename: S J
authors.initials: SJ
authors.lastname: Smith
authors.forename: J S
authors.initials: JS
authors.lastname: Duncan
authors.forename: J W
authors.initials: JW
authors.lastname: Sander
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004828:Epilepsies, Partial / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012044:Regression Analysis; D012640:Seizures / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult