title: Long-term approach to patients with postsurgical seizures.
abstract: OBJECTIVE
  The main purpose of the study was to analyze the long-term outcomes and therapeutic approaches for patients with seizures within the first year after surgery. The secondary aim of the study was to evaluate the relationship between 1-year outcome and long-term outcome and choice of therapy.
  
  
  METHODS
  Our study was a retrospective investigation of the long-term outcomes of 95 patients (33.5% of all surgically treated patients) with seizure recurrence in the first year after surgery. The patients had follow-up visits for >5 years.
  
  
  RESULTS
  At the 5-year follow-up visit (FU5), 28 (29.5%) of the 95 patients were completely seizure-free (International League Against Epilepsy (ILAE) class 1), 17 (17.9%) had auras only (ILAE class 2), and 21 (22.1%) were unimproved (ILAE classes 5 and 6). Statistically significant factors for these long-term outcomes were the focus localization of the epilepsy, preoperative MRI findings, and postoperative follow-up results in the first year. The patients with <3 seizure days in the first postoperative year (ILAE 3) represented 53.6% of the seizure-free patients at FU5; the patients with auras in the first year constituted 64.7% of the patients with only auras at FU5; and the patients unimproved in the first year represented 76.2% of the unimproved patients at FU5.
  
  
  CONCLUSIONS
  Postoperative outcome depends to a certain extent on the outcome achieved in the first postoperative year. More than one third of the patients with postoperative seizures reached a long-term seizure-free outcome, and more than half of them did not experience disabling seizures in the last outcome year. The most therapeutic options were used in patients who were minimally influenced by the operation; the majority of patients with considerable improvement because of the operation do not use any other add-on antiepileptic drugs or other kinds of therapy.
authors.affiliation: Department of Child Neurology, Brno Epilepsy Center, Brno University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Ryzí
authors.affiliation: Department of Child Neurology, Brno Epilepsy Center, Brno University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Hana
authors.initials: H
authors.lastname: Ošlejšková
authors.affiliation: First Department of Neurology, Brno Epilepsy Center, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.|Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Rektor
authors.affiliation: Department of Neurosurgery, Brno Epilepsy Center, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Zdeněk
authors.initials: Z
authors.lastname: Novák
authors.affiliation: Department of Neurosurgery, Brno Epilepsy Center, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Hemza
authors.affiliation: Department of Neurosurgery, Brno Epilepsy Center, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Chrastina
authors.affiliation: Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Svoboda
authors.affiliation: First Department of Pathological Anatomy, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Markéta
authors.initials: M
authors.lastname: Hermanová
authors.affiliation: First Department of Neurology, Brno Epilepsy Center, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.|Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Brázdil
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000639:trends*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Add-on medication; Postoperative treatment; Reoperation; Surgery failure; Vagus nerve stimulation