Clinical Factors Associated with Late Seizure Remission After Failed Epilepsy Surgery
Abstract number :
2.278
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2204584
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Lesley Kaye, MD – University of Colorado School of Medicine; Zoe Poolos, BA – Carleton College; John Miller, MD, PhD – Professor, Neurology, University of Washington; Nicholas Poolos, MD, PhD – Professor, Neurology, University of Washington
Rationale: Some patients who initially fail epilepsy surgery later become seizure-free, but it is not clear how the clinical characteristics of the patients or post-operative modifications of anti-seizure medication (ASM) regimens contribute to late seizure remission.
Methods: We performed a retrospective chart review of patients undergoing epilepsy surgery at the University of Washington Regional Epilepsy Center between 2007-2017, including patients receiving neocortical resection, temporal lobectomy, and hippocampal laser interstitial therapy (LITT) ablation. We assessed seizure freedom, ASM changes, seizure frequency at first and last follow-up, and type of lesion. Two-tailed Fisher’s exact test and Mann-Whitney U test were used for statistical analyses.
Results: A total of 215 patients undergoing epilepsy surgery between 2007-2017 had both first and last follow-up. 98 of these 215 patients (46%) were not seizure-free at the first follow-up (mean 1.1 years post-operative). By last follow-up (mean 4.7 years post-operative), 20/98 (20%) of those not initially seizure-free had become so. Those who were seizure-free at last visit had significantly lower median number of seizures per month in the first post-operative year (0.21 versus 0.95 per month in those not seizure-free, p< 0.001). There was also a significantly higher proportion of patients with cavernomas who were seizure-free at last visit (25% vs. 1%; p=0.001), but no other differences in clinical characteristics. Of the 98 patients who had seizures at first follow up, 62/98 (63%) underwent post-operative modification of their ASM regimens. The rate of late seizure freedom was similar for patients with or without ASM changes: 13/62 (21%) were seizure-free at last visit with ASM changes and 7/36(19%) without ASM changes. There were no significant differences in which ASMs were changed between those who became seizure-free and those who did not, but patients who underwent further medical management were less likely to have had mesial temporal sclerosis (MTS) than those who did not.
Surgery