title: Long-term outcomes of epilepsy surgery in Sweden: a national prospective and longitudinal study.
abstract: OBJECTIVE
  To investigate prospective, population-based long-term outcomes concerning seizures and antiepileptic drug (AED) treatment after resective epilepsy surgery in Sweden.
  
  
  METHODS
  Ten- and 5-year follow-ups were performed in 2005 to 2007 for 278/327 patients after resective epilepsy surgery from 1995 to 1997 and 2000 to 2002, respectively. All patients had been prospectively followed in the Swedish National Epilepsy Surgery Register. Ninety-three patients, who were presurgically evaluated but not operated, served as controls.
  
  
  RESULTS
  In the long term (mean 7.6 years), 62% of operated adults and 50% of operated children were seizure-free, compared to 14% of nonoperated adults (p < 0.001) and 38% of nonoperated children (not significant). Forty-one percent of operated adults and 44% of operated children had sustained seizure freedom since surgery, compared to none of the controls (p < 0.0005). Multivariate analysis identified ≥30 seizures/month at baseline and long epilepsy duration as negative predictors and positive MRI to be a positive predictor of long-term seizure-free outcome. Ten years after surgery, 86% of seizure-free children and 43% of seizure-free adults had stopped AEDs in the surgery groups compared to none of the controls (p < 0.0005).
  
  
  CONCLUSIONS
  This population-based, prospective study shows good long-term seizure outcomes after resective epilepsy surgery. The majority of the patients who are seizure-free after 5 and 10 years have sustained seizure freedom since surgery. Many patients who gain seizure freedom can successfully discontinue AEDs, more often children than adults.
  
  
  METHODS
  This study provides Class III evidence that more patients are seizure-free and have stopped AED treatment in the long term after resective epilepsy surgery than nonoperated epilepsy patients.
authors: From the Epilepsy Research Group, Institute of Neuroscience and Physiology (A.E., B.R., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University; Departments of Clinical Neurophysiology (R.F.) and Neurology (E.K.), Uppsala University Hospital; and Department of Neurology (K.K.), Institution of Clinical Neurosciences, Lund University, Sweden.
authors: Anna
authors: A
authors: Edelvik
authors: Bertil
authors: B
authors: Rydenhag
authors: Ingrid
authors: I
authors: Olsson
authors: Roland
authors: R
authors: Flink
authors: Eva
authors: E
authors: Kumlien
authors: Kristina
authors: K
authors: Källén
authors: Kristina
authors: K
authors: Malmgren
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D004827:Epilepsy / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012640:Seizures / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
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