title: A reappraisal of mortality after epilepsy surgery.
abstract: To assess whether epilepsy surgery is associated with a reduction in mortality rate and if postoperative seizure frequency and severity affect mortality.
  
  
  
  A total of 1,110 patients were evaluated (1,006 surgically and 104 nonsurgically treated) for a total follow-up of 8,126.62 person-years from 1986 to 2013. Deaths were ascertained through database and Social Security Death Index query. Patients were grouped by surgery type and seizure status; standardized mortality ratio and deaths per 1,000 person-years were calculated. Survival analysis and Cox proportional hazard regression were performed.
  
  
  
  Eighty-nine deaths were observed. Surgically treated patients had a lower mortality rate (8.6 per 1,000 person-years [95% confidence interval (CI) 6.58-11.15]) than nonsurgically treated patients (25.3 per 1,000 person-years [14.50-41.17]; p < 0.001). Seizure-free patients had a lower mortality rate (5.2 per 1,000 person-years [95% CI 2.67-9.02]) than non-seizure-free patients (10.4 per 1,000 person-years [95% CI 7.67-13.89] p = 0.03). More frequent postoperative tonic-clonic seizures (>2 per year) were associated with increased mortality (p = 0.006) whereas complex partial seizure frequency was not related to death rate. Mortality was similar in temporal and extratemporal epilepsy patients (p = 0.7).
  
  
  
  Brain surgery is associated with a reduction in mortality rate in drug-resistant epilepsy, both when seizures are abolished and when it results in significant palliation of tonic-clonic seizure frequency. These observations provide further rationale for earlier consideration of epilepsy surgery.
authors.affiliation: From Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA. michael.sperling@jefferson.edu.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Sperling
authors.affiliation: From Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Barshow
authors.affiliation: From Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Maromi
authors.initials: M
authors.lastname: Nei
authors.affiliation: From Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Asadi-Pooya
mesh_terms: D001921:Brain / Q000601:surgery; D003645:Death, Sudden; D000069279:Drug Resistant Epilepsy / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012640:Seizures / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome