Long-term outcomes of surgical treatment for epilepsy in adults with regard to seizures, antiepileptic drug treatment and employment. (January 2017)

• Record Type: Journal Article
• Authors: Malmgren, Kristina; Edelvik, Anna
• Is Part Of: Seizure. Volume 44(2017)
• Page Start: 217
• Page End: 224
• Publication Date: 2017-01
• Subjects: Epilepsy surgery -- Long-term outcomes -- Seizure outcome -- Antiepileptic drugs -- Employment outcome -- Vocational outcome; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2016.10.015
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Long-term seizure freedom in adults since temporal lobe resection is around 50%. A higher proportion has been seizure-free at least a year at each time-point assessed. Proportion seizure-free off anti-epileptic drugs long-term after surgery varies. Long-term employment outcomes are not consistent across studies. Abstract: Purpose: 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 The proportion of seizure-free adults in whom AEDs have been withdrawn varied widely across studies, from 19–63% after around 5 years of seizure freedom.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.