title: Long-term outcomes of surgical treatment for epilepsy in adults with regard to seizures, antiepileptic drug treatment and employment.
abstract: OBJECTIVE
  There is Class I evidence for short-term efficacy of epilepsy surgery from two randomized controlled studies of temporal lobe resection. Long-term outcome studies are observational. The aim of this narrative review was to summarise long-term outcomes taking the study methodology into account.
  
  
  METHODS
  A PubMed search was conducted identifying articles on long-term outcomes of epilepsy surgery in adults with regard to seizures, antiepileptic drug treatment and employment. Definitions of seizure freedom were examined in order to identify the proportions of patients with sustained seizure freedom. The quality of the long-term studies was assessed.
  
  
  RESULTS
  In a number of high-quality studies 40-50% of patients had been continuously free from seizures with impairment of consciousness 10 years after resective surgery, with a higher proportion seizure-free at each annual follow-up. The proportion of seizure-free adults in whom AEDs have been withdrawn varied widely across studies, from 19-63% after around 5 years of seizure freedom. Few long-term vocational outcome studies were identified and results were inconsistent. Some investigators found no postoperative changes, others found decreased employment for patients with continuing seizures, but no change or increased employment for seizure-free patients. Having employment at baseline and postoperative seizure freedom were the strongest predictors of employment after surgery.
  
  
  CONCLUSIONS
  Long-term studies of outcomes after epilepsy surgery are by necessity observational. There is a need for more prospective longitudinal studies of both seizure and non-seizure outcomes, considering individual patient trajectories in order to obtain valid outcome data needed for counselling patients about epilepsy surgery.
authors.affiliation: Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: kristina.malmgren@neuro.gu.se.
authors.forename: Kristina
authors.initials: K
authors.lastname: Malmgren
authors.affiliation: Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Edelvik
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004651:Employment; D004827:Epilepsy / Q000188:drug therapy / Q000523:psychology / Q000601:surgery; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D039781:PubMed / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drugs; Employment outcome; Epilepsy surgery; Long-term outcomes; Seizure outcome; Vocational outcome