title: Comparing the effects of cortical resection and vagus nerve stimulation in patients with nonlesional extratemporal epilepsy.
abstract: The main purpose of this retrospective study was to compare the effects of resective surgery (RESgr-26 patients) and vagus nerve stimulation (VNSgr-35 patients) on seizure frequency (2 and 5years after surgery) in patients with nonlesional extratemporal epilepsy (NLexTLE). We analyzed hospital admission costs directly associated with epilepsy (HACE) in both groups at the same follow-up. The decrease in seizure frequency from the preoperative levels, in both VNSgr and RESgr, was statistically significant (p<0.001). The seizure frequency reduction did not differ significantly between the follow-up visits for either group (p=0.221 at 2years and 0.218 at 5years). A significantly higher number of Engel I and Engel I+II patients were found in RESgr than in VNSgr at both follow-up visits (p=0.04 and 0.007, respectively). Using McHugh classification, we did not find statistically significant differences between both groups at both follow-up visits. Hospital admission costs directly associated with epilepsy/patient/year in both RESgr and VNSgr dropped significantly at 2- and 5-year follow-up visit and this reduction was not statistically different between RESgr and VNSgr (p=0.232). Both VNS and resective surgery cause comparably significant seizure reduction in NLexTLE. Resective surgery leads to a greater number of patients with excellent postoperative outcome (Engel I+II). The HACE reduction is statistically comparable between both groups.
authors.affiliation: Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic. robert.kuba@fnusa.cz
authors.forename: Robert
authors.initials: R
authors.lastname: Kuba
authors.forename: Zdeněk
authors.initials: Z
authors.lastname: Novák
authors.forename: Jan
authors.initials: J
authors.lastname: Chrastina
authors.forename: Marta
authors.initials: M
authors.lastname: Pažourková
authors.forename: Markéta
authors.initials: M
authors.lastname: Hermanová
authors.forename: Hana
authors.initials: H
authors.lastname: Ošlejšková
authors.forename: Ivan
authors.initials: I
authors.lastname: Rektor
authors.forename: Milan
authors.initials: M
authors.lastname: Brázdil
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D002540:Cerebral Cortex / Q000601:surgery*; D003365:Costs and Cost Analysis; D003952:Diagnostic Imaging; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019635:Neurosurgical Procedures / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000191:economics / Q000379:methods*
chemical_list: D000927:Anticonvulsants
keywords: Cortical resection; Cost analysis; Epilepsy surgery; Nonlesional extratemporal epilepsy; Vagus nerve stimulation