title: Long-term seizure and psychosocial outcomes after resective surgery for intractable epilepsy.
abstract: Resective surgery is considered an effective treatment for refractory localization-related epilepsy. Most studies have reported seizure and psychosocial outcomes of 2-5 years postsurgery and a few up to 10 years. Our study aimed to assess long-term (up to 15 years) postsurgical seizure and psychosocial outcomes at our epilepsy center. The Henry Ford Health System Corporate Data Store was accessed to identify patients who had undergone surgical resection for localization-related epilepsy from 1993 to 2011. Demographics including age at epilepsy onset and surgery, seizure frequency before surgery, and pathology were gathered from electronic medical records. Phone surveys were conducted from May 2012 to January 2013 to determine patients' current seizure frequency and psychosocial metrics including driving and employment status and use of antidepressants. Surgical outcomes were based on Engel's classification (classes I and II=favorable outcomes). McNemar's tests, chi-square tests, two sample t-tests, and Wilcoxon two sample tests were used to analyze the relationships of psychosocial and surgical outcomes with demographic and surgical characteristics. A total of 470 patients had resective epilepsy surgery, and of those, 50 (11%) had died since surgery. Of the remaining, 253 (60%) were contacted with mean follow-up of 10.6±5.0years (27% of patients had follow-up of 15 years or longer). Of the patients surveyed, 32% were seizure-free and 75% had a favorable outcome (classes I and II). Favorable outcomes had significant associations with temporal resection (78% temporal vs 58% extratemporal, p=0.01) and when surgery was performed after scalp EEG only (85% vs 65%, p<0.001). Most importantly, favorable and seizure-free outcome rates remained stable after surgery over long-term follow-up [i.e., <5 years (77%, 41%), 5-10 years (67%, 29%), 10-15 years (78%, 38%), and >15 years (78%, 26%)]. Compared to before surgery, patients at the time of the survey were more likely to be driving (51% vs 35%, p<0.001) and using antidepressants (30% vs 22%, p=0.013) but less likely to be working full-time (23% vs 42%, p<0.001). A large majority of patients (92%) considered epilepsy surgery worthwhile regardless of the resection site, and this was associated with favorable outcomes (favorable=98% vs unfavorable=74%, p<0.001). The findings suggest that resective epilepsy surgery yields favorable long-term postoperative seizure and psychosocial outcomes.
authors.affiliation: Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA. Electronic address: vwasade1@hfhs.org.
authors.forename: Vibhangini S
authors.initials: VS
authors.lastname: Wasade
authors.affiliation: Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Kost
authors.initials: K
authors.lastname: Elisevich
authors.affiliation: Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Tahir
authors.affiliation: Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Brien
authors.initials: B
authors.lastname: Smith
authors.affiliation: Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Lonni
authors.initials: L
authors.lastname: Schultz
authors.affiliation: Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Schwalb
authors.affiliation: Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Marianna
authors.initials: M
authors.lastname: Spanaki-Varelas
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D001334:Automobile Driving / Q000706:statistics & numerical data; D004351:Drug Resistance; D004569:Electroencephalography; D004651:Employment; D004827:Epilepsy / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D012640:Seizures / Q000523:psychology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: Epilepsy; Epilepsy surgery; Long-term outcome; Psychosocial; Resective surgery