title: Long-term seizure outcome following resective surgery for epilepsy: to be or not to be completely cured?
abstract: Surgical intervention is expected to improve the quality of life in patients with intractable epilepsy by providing adequate seizure control. Although many previous studies showed various rates of seizure freedom, definite conclusions have not yet been made regarding outcomes. In order to clarify the long-term postoperative outcome for a period up to 10 years, a retrospective review of our patients was performed longitudinally by using the survival analysis method. The postoperative state of epilepsy in 76 patients who underwent resection surgery was assessed based on Engel's criteria. In addition, Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom. In this patient group, abnormal lesion were detected by MRI in 70 out of 76 cases, and the ictal onset zone was finally identified within temporal lobe in 51 cases. The most favorable outcome, defined as Engel Class Ia, was observed in 26 (37%), 24 (40%), and 18 (41%) cases at 2, 5, and 10 years after surgery, respectively. The Kaplan-Meier survival curve in the overall group estimated the probability of seizure freedom as 75% (95% confidence interval [CI] 70-80%), 67% (62-72%), and 51% (45-57%) at 2, 5, and 10 years follow up, respectively. Half of all seizure recurrences occurred within the first 2 postoperative years. In this study, we showed that long-term favorable outcome of seizure control following resection surgery can be achieved in more than half of the patients.
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine.
authors.forename: Takeharu
authors.initials: T
authors.lastname: Kunieda
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Mikuni
authors.forename: Sumiya
authors.initials: S
authors.lastname: Shibata
authors.forename: Rika
authors.initials: R
authors.lastname: Inano
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yamao
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kikuchi
authors.forename: Riki
authors.initials: R
authors.lastname: Matsumoto
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.forename: Akio
authors.initials: A
authors.lastname: Ikeda
authors.forename: Hidenao
authors.initials: H
authors.lastname: Fukuyama
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D004827:Epilepsy / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants