Abstracts

Rationale: Epilepsy surgery remains one of the main stakes of modern epilepsy therapy in the patients with drug-resistant epilepsy. The epilepsy program Geneva-Lausanne has been founded in 1995, as the second surgical program in Switzerland. Advanced techniques for focus localization such as electric source localization, EEG-fMRI or co-registration of all techniques have been developed and integrated in the clinical routine, whenever felt necessary. The aim of this study was to assess: a) if our concept of comprehensive care has improved post-surgical outcomes and b) if patients were referred at a younger age, given the increased availability of epilepsy surgery and technical improvements.Methods: This is a retrospective study of consecutive patients, who were evaluated in our center since 1995. We identified 661 patients in our data bank referred for epilepsy surgery (228 were <16 years). Clinical/demographic data, preoperative evaluations and surgical outcomes (using Engel scale) were collected and analysed. Comparisons were carried out using chi-square tests or non-parametric t-tests when appropriate. Spearman rank analysis was applied to determine trends over time.Results: 335 were operated (51%), 294 with a curative aim. 208 of the 661 evaluated patients suffered from non-lesional epilepsy (31.5%). There was a trend towards shorter epilepsy duration (p=0.07) throughout the 20 years, due to an increasing number of paediatric referrals, but epilepsy duration did not decrease significantly over time within the adult (18 +/- 12 y) or paediatric (5.9 +/- 4.4 y) population (not significant, n.s.). The proportion of Class I Engel patients did not change over time (p=0.2), however, the proportion of operated non-lesional cases increased over time (p=0.017). Overall, 210 patients (71%) were seizure-free (Engel I at an average follow-up of 38 months), including 151 patients who underwent temporal and 85 with extra-temporal resection. 20/27 non-lesional (74%) and 190/228 (83%) lesional epilepsy patients were seizure-free (p=0.2). Concerning only non-lesional cases, again there was no significant difference in outcome between temporal and extratemporal lobe epilepsy.Conclusions: While epilepsy duration did not become shorter over the years, despite increased accessibility of epilepsy surgery, patients with non-lesional epilepsy were more readily referred. Comprehensive patient care provided equally good results for non-lesional and lesional epilepsy.