Seizure outcome and its predictors after frontal lobe epilepsy surgery. (8th July 2019)

• Record Type: Journal Article
• Authors: Samuel P, Joseph; Menon, Ramshekhar N.; Chandran, Anuvitha; Thomas, Sanjeev V.; Vilanilam, George; Abraham, Mathew; Radhakrishnan, Ashalatha
• Is Part Of: Acta neurologica Scandinavica. Volume 140:Number 4(2019)
• Page Start: 259
• Page End: 267
• Publication Date: 2019-07-08
• Subjects: frontal lobe epilepsy -- outcome -- predictors -- surgery; Neurology -- Periodicals; 616.8
• DOI: 10.1111/ane.13139
• Languages: English
• ISSNs: 0001-6314

Abstract

Abstract : Objectives: Frontal lobe epilepsy (FLE) surgery is the second most common focal resective surgery for drug‐resistant epilepsy. Not many studies are available regarding the long‐term surgical outcome of FLE. We studied the longitudinal outcome and predictors of seizure outcome following FLE surgery in a sizeable cohort of patients. Materials & Methods: A total of 73 consecutive patients who underwent FLE surgery between January 1997 and May 2015 with a minimum follow‐up of 1 year (range 1‐16 years) were studied. Primary outcome was seizure freedom at last follow‐up (Engel Class IA). "Seizure freedom" separately was defined as absence of seizures till last follow‐up. Outcome predictors were subjected to multivariate analysis. Using Kaplan‐Meier curve, we assessed the post‐operative seizure freedom over time. Results: Twenty‐five patients (34%) were seizure‐free till last follow‐up. The seizure freedom was 45%, 34%, 26%, 20% and 14% at the end of 1st, 2nd, 3rd, 4th and 5th post‐operative year, respectively. Engel class I outcomes were 48%, 41%, 56%, 57% and 53% at end of 1st, 2nd, 3rd, 4th and 5th post‐operative year, respectively. Predictors of seizure recurrence on multivariate analysis were older age at surgery ( P = 0.032), longer duration of epilepsy ( P = 0.031), presence of interictal epileptiform discharges in post‐operative EEG on 7th day ( P = 0.005), 3 months ( P = 0.005) and 1 year ( P = 0.0179). In subgroup analysis, duration of epilepsy of less than 2 years before surgery was a significant predictor for achieving seizure freedom ( P = 0.029). Conclusions: These results emphasize early surgery for better outcome in frontal lobe epilepsy. Post‐operative EEG remained a good predictor for long‐term outcome.