Rationale:
Traumatic brain injury is a common, disabling condition with a myriad of associated sequelae that significantly affect patients’ quality of life.
1 Prior studies indicate that compared to those with non-traumatic epilepsy, patients with post-traumatic epilepsy (PTE) may be more likely to develop drug-resistant epilepsy (DRE) and to report a lower quality of life.
2 Furthermore, research suggests that epilepsy surgery may be particularly underutilized in this population.
1 Despite multifocal epileptogenicity and diffuse neuropsychological deficits, surgical management may be effective in treating drug-resistant PTE.
1 Here, we present surgical outcomes in a modern cohort of patients with drug-resistant PTE.
1 He, X., Guan, Y., Zhai, F., Zhou, J., Li, T., & Luan, G. (2020). Resective surgery for drug-resistant posttraumatic epilepsy: Predictors of seizure outcome. J Neurosurg, 133 (5), 1568-1575.
2 Gugger, J. J., Kennedy, E., Panahi, S., Tate, D. F., Roghani, A., Van Cott, A. C., Lopez, M. R., Altalib, H., Diaz-Arrastia, R., & Pugh, M. J. (2022). Multimodal quality of life assessment in post-9/11 veterans with epilepsy. Neurology, 98(17), e1761-e1770.
Methods:
This study involved a retrospective cohort of patients with PTE seeking care at the University of Pittsburgh Epilepsy Monitoring Unit (EMU) from January 2005 to April 2022. The duration of epilepsy prior to presentation to the EMU as well as the number of anti-epilepsy drugs trialed was recorded. For patients who underwent epilepsy surgery, outcomes were evaluated according to both the Engel Epilepsy Surgery Outcome Scale as well as the International League Against Epilepsy (ILAE) classification one year following surgery as well as at last follow-up.
Results:
Of the cohort of 22 patients, 64% (14/22) underwent intracranial monitoring and 59% (13/22) subsequently underwent epilepsy surgery. Of the patients who had epilepsy surgery, 62% (8/13) underwent resective surgery whereas 15% (2/13) and 23% (3/13) underwent RNS or VNS placement, respectively. These classifications are one year after surgery. Of the patients who underwent resective surgeries, 50% (4/8) were Engel class I. A total of 38% (3/8) were Engel class II and 12% (1/8) were Engel class III. Regarding ILAE classification, 38% (3/8) had no seizures (class 1), 50% (4/8) had one to three seizure days per year (class 3), and 13% (1/8) had four seizures per year to 50% reduction of baseline seizure days (class 4). For patients who underwent neuromodulation, either RNS or VNS, 20% (1/5) had an Engel class II score, 40% (2/5) had an Engel class III score, and 40% (2/5) had an Engel class IV score. For ILAE classification of the neuromodulation cohort, 20% (1/5) were categorized as class 4, 60% (3/5) were class 5 indicating less than 50% reduction in seizures, and 20% (1/5) had a more than 100% increase in baseline seizure days (class 6).
Conclusions:
This study characterized outcomes in drug-resistant PTE and indicates the benefit of resective surgery after intracranial monitoring in this population.
Funding: None