Abstracts

Rationale: Epilepsy is a highly prevalent disease, with 30% of patients being resistant to anti-epileptic drugs (AEDs). For these patients, epilepsy surgery is a safe and viable option for treatment, with between 50-80% of patients seizure free after surgery. Still, only 1% of appropriate patients undergo surgery. To help address this disparity, the University of Kansas Comprehensive Epilepsy Center revived its surgical epilepsy program five years ago. Methods: A retrospective chart review from January 2013 until January 2019 was performed at the University of Kansas Medical Center to assess our patient demographics and surgical outcomes. This study was approved by the University of Kansas Medical Center Instutional Review Board. Two-sided Pearson Chi-Square or Fisher’s Exact Test is used to analyze categorical variables. Results: There were 100 patients [58 resection, 17 laser interstitial thermal therapy (LITT), 7 responsive neurostimulator (RNS), 4 radiofrequency ablation, 2 corpus callosotomy(CC), and 12 patients with repeat intervention]. The number of surgical cases increased each year since the program’s reinitiation. 55 patients had at least one year follow-up following surgery. The average age was 43.0±14.8 years and the average epilepsy duration prior to epilepsy surgery was 21.7±16.1 years. Intracranial monitoring was done in 73% of the patients. Seizure freedom rate was 62% for whole group. For patients with at least one year follow up (N=55), seizure free rate was 64% with a mean and median duration of 23.6± 3.0 and 16.0 months respectively. Of note, seizure freedom rates for ATL vs LITT for mesial temporal epilepsy were not statistically different for either whole group or with at least one year follow-up after the last procedure [78% vs 61% (X2=1.956, p=0.162); 77% vs 65% (Fisher’s exact test, p=0.482), respectively]. For neocortical resections, the seizure freedom rate was 64% for whole group and 69% for patients with at least one year follow-up. Lastly of interest, among patient who had failed LITT three became seizure free after anterior temporal lobectomy.Complications occurred in 12% of the patients. The most common complication was scalp infection (5%). Acute encephalopathy occurred in 2% which completely resolved. Intracranial hemorrhage and ischemic stroke occurred in 3% and 1% of the patients, respectively. CNS infection was seen in only one patient (1%). Conclusions: Epilepsy surgery is an effective treatment for medically refractory epilepsy. Our findings suggest that outcomes from a recently reestablished center can be similar to outcomes from established centers. Surgical volume growth can be expected with institutional support as well as increasing patient and physician awareness. Funding: No funding