title: Clinical predictors of 2-year outcome of resective epilepsy surgery in adults with refractory epilepsy: a cohort study.
abstract: OBJECTIVE
  Resective epilepsy surgery is currently a standard treatment for intractable epilepsy. Seizure freedom and discontinuation of antiepileptic drugs are the ultimate goals of epilepsy treatment. This study was carried out to delineate (1) possible differences in the success rate of epilepsy surgery 6 and 24 months after surgery; and (2) the clinical predictors of a good response to surgery.
  
  
  METHODS
  This is a cohort study performed at a tertiary care unit of a university hospital.
  
  
  METHODS
  In this cohort study, 189 adults with intractable epilepsy who underwent epilepsy surgery were included. We collected clinical data at three time points, that is, preoperative and 6 and 24 months after surgery.
  
  
  METHODS
  Engel class I-IV classification was the primary outcome measure of epilepsy surgery. The authors statistically adjusted Engel class I-IV classification for postoperative changes in antiepileptic drugs and used this new classification as a secondary outcome variable.
  
  
  RESULTS
  The success rate was 78.8% 6 months after surgery and increased to 88.3% 24 months after surgery. This success rate was reflected not only by the reduced number of seizures postsurgery, but also by a reduced dosage and use of antiepileptic drugs. Logistic regression analysis showed that a successful outcome of surgery is predicted by having temporal rather than extratemporal lobe epilepsy and less than nine presurgery seizures per month, while a positive familial history of epilepsy, younger age and dysphoric symptoms, the first 3 months after surgery, significantly worsened the outcome of surgery. Duration of illness, age at onset, epilepsy location, type of lesions and the presence of psychosis were not significant in predicting treatment outcome.
  
  
  CONCLUSIONS
  These findings have clinical relevance in that a better selection of patients based on the significant clinical predictors will increase the success rate of epilepsy surgery and treatment.
authors.affiliation: Faculty of Medicine, Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand.
authors.forename: B
authors.initials: B
authors.lastname: Kanchanatawan
authors.forename: C
authors.initials: C
authors.lastname: Limothai
authors.forename: T
authors.initials: T
authors.lastname: Srikijvilaikul
authors.forename: M
authors.initials: M
authors.lastname: Maes
mesh_terms: D000328:Adult; D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use; D000069279:Drug Resistant Epilepsy / Q000145:classification / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: Neurosurgery
references.citation: Brain. 2005 Feb;128(Pt 2):395-404
references.pmid: 15634733
references.citation: Epilepsia. 2012 Apr;53(4):712-20
references.pmid: 22313356
references.citation: Seizure. 2012 Jul;21(6):444-9
references.pmid: 22591658
references.citation: Seizure. 2011 May;20(4):276-9
references.pmid: 21216629
references.citation: Neurology. 2004 Jul 13;63(1):57-65
references.pmid: 15249611
references.citation: Epilepsy Res. 2012 Jun;100(1-2):55-8
references.pmid: 22336897
references.citation: Brain Dev. 2013 Sep;35(8):810-5
references.pmid: 23688973
references.citation: Br J Neurosurg. 2014 Jan;28(1):61-7
references.pmid: 23885724
references.citation: Epilepsy Res. 2009 Oct;86(2-3):191-9
references.pmid: 19632095
references.citation: Epilepsia. 2011 Mar;52(3):627-35
references.pmid: 21219315
references.citation: Ann Neurol. 2013 May;73(5):646-54
references.pmid: 23494550
references.citation: Neurosci Biobehav Rev. 2007;31(6):858-73
references.pmid: 17555817
references.citation: Hum Mutat. 2014 Mar;35(3):356-67
references.pmid: 24375629
references.citation: Epilepsia. 2012 Jan;53(1):44-50
references.pmid: 21955142
references.citation: Childs Nerv Syst. 2008 Dec;24(12):1437-45
references.pmid: 18704447
references.citation: Epilepsy Behav. 2012 Aug;24(4):462-7
references.pmid: 22789634
references.citation: Epilepsy Behav. 2004 Dec;5(6):826-40
references.pmid: 15582829
references.citation: Epilepsia. 2010 Jul;51(7):1139-45
references.pmid: 20059526
references.citation: Acta Neurochir (Wien). 2010 Aug;152(8):1299-305
references.pmid: 20524016
references.citation: Neurology. 2013 Oct 1;81(14):1244-51
references.pmid: 23966252
references.citation: Curr Opin Neurol. 2013 Apr;26(2):208-13
references.pmid: 23429545
references.citation: Ann Neurol. 1998 Apr;43(4):435-45
references.pmid: 9546323
references.citation: Brain. 2007 Feb;130(Pt 2):334-45
references.pmid: 17124190
references.citation: Psychoneuroendocrinology. 2013 Feb;38(2):263-70
references.pmid: 22749310
references.citation: Epilepsia. 2008 Apr;49(4):650-6
references.pmid: 18093149
references.citation: Neurology. 2009 Mar 3;72(9):793-9
references.pmid: 19255406
references.citation: Epilepsia. 2012 Oct;53(10):1700-4
references.pmid: 22738237
references.citation: Lancet Neurol. 2012 Sep;11(9):784-91
references.pmid: 22841352
references.citation: Epilepsy Behav. 2012 Oct;25(2):208-13
references.pmid: 23032134
references.citation: Hum Mol Genet. 2014 Jan 1;23(1):247-58
references.pmid: 23962720
references.citation: Ann Neurol. 1996 Apr;39(4):442-9
references.pmid: 8619522
references.citation: J Neurol Neurosurg Psychiatry. 2013 Jul;84(7):800-5
references.pmid: 23408065
references.citation: Epilepsy Behav. 2009 Mar;14(3):529-34
references.pmid: 19186216
references.citation: Epilepsy Res. 2013 Sep;106(1-2):264-72
references.pmid: 23642574
references.citation: Epilepsia. 2012 Oct;53(10):1705-12
references.pmid: 22881990
references.citation: Lancet. 2011 Oct 15;378(9800):1388-95
references.pmid: 22000136
references.citation: J Med Assoc Thai. 2012 Sep;95(9):1232-8
references.pmid: 23140043