Abstracts

Little is known about the long term outcome of patients with medically refractory epilepsy who undergo presurgical evaluation but are not considered good surgical candidates or reject surgery. A previous study with a small number of patients found out that up to 20% of those patients may eventually become seizure free (Selwa et al, 2003). This information is essential to counsel patients attended in a surgical programme., We performed a retrospective chart review and telephone survey on all patients who had undergone presurgical evaluation at the Epilepsy Monitoring Unit (EMU) of Hospital Clinic (Barcelona, Spain) from 1995 until 2004, but did not undergo epilepsy surgery afterwards, either because they were not considered to be good surgical candidates or because the patient declined surgery. We inquired about current seizure frequency, antiepileptic drug treatment, overall impression of change, quality of life, marital and laboral situation., From a total of 167 telephone calls, we finally contacted 80 patients who agreed to answer the survey. Of them, only 7 patients (9.3%) were currently seizure free, with a mean seizure free period of 3 years (2-6). Seizure freedom was associated with use of new AEDs in 2/7 patients. Five patients (6.2%) had died, with death being possibly related to seizures (SUDEP or CRA during prolonged seizures) in all of them. Among those patients who were not seizure free, the vast majority (89%) reported that their seizure frequency was either the same or lower than at the time of presurgical evaluation.
No significant differences were found between seizure free and not seizure free patients respect to the type of epilepsy, etiology, presence of a lesion on the MRI and reason not to have surgery.
Overall, 54% of all patients interviewed reported feeling better and more satisfied with their lives than when they were admitted to the EMU.
Although most patients did not report changes in their marital or laboral status, a higher proportion of patients in the seizure free group (71%) were actively working, compared to 32% of patients in the group with continued seizures., A small percentage (9.3%) of patients with refractory epilepsy who undergo presurgical evaluation but not epilepsy surgery may eventually become seizure free on drugs. Up to 6% of patients may die as a consequence of their epilepsy. In patients who do not become seizure free, seizure frequency will be, in general, similar or lower with time, and up to 50% of patients will report feeling better and more satisfied with their lives than at the moment of presurgical evaluation. This information may be used to counsel patients attending epilepsy surgery programmes.,