Outcome Studies of Surgery of Epilepsy by the Dutch Collaborative Epilepsy Surgery Program. Seizure Control, Complications and Medication.
Abstract number :
F.10
Submission category :
Year :
2000
Submission ID :
728
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Rene Debets, Peter C Van Rijen, Walter Van Emde Boas, Geert JF Brekelmans, Ellen Veltman, Cees WM Van Veelen, Jeroen Verheul, Epilepsy Institute SEIN, Heemstede, Netherlands; Dept Neurosurgery, Univ Medical Ctr Utrecht, Utrecht, Netherlands; Epilepsy Ins
Seizure outcome: Of a total of 389 surgeries, 338 had a follow-up of more than 1 year. Seizure outcome classification was done according to the UCLA system. Temporal lobe resections performed in 269 patients resulted after a mean follow-up of 4.1 years in 43% in UCLA class 1A, in 64% in class 1A-D and in 90% in a class 1+2 outcome. Extensive resections (more than 3 cm neocortical resection + Amygdala-Hippocampectomy (AH)) were not more succesful than smaller resections (less than 3 cm + AH). At ten years follow-up (18 patients) 61% was in class I and 77% in class 1+2. Fourty-one extratemporal resections with a mean follow-up of 5 years resulted in 41% of the patients in class IA, in 48% in class 1A-D and in 66% in a class 1+2 outcome. In frontal lobe epilepsy resections based on depth-EEG recording were significantly more succesful than lesionectomy. Callosotomy, anterior in 9 and total in 1 patient, was succesful (class 1) in one. Eight patients scored class 3 or 4. N. Vagus stimulation was beneficial in 1 of 6 patients. Complications: In 16 patients physical complications (5%) have occurred of which 12 were transient. In 3 patients (less than 1%) they were permanent: respectively a hemiparesis, a Sudecks atrofy and in one patient a mild aphasia. In a subseries of 155 TLE patients a postoperative visual field deficit of (slightly) more than a quadrant hemianopsia was found in 7 (5%). They were remarked by two patients (1%). Thirty-seven patients (14%) had psychiatric problems; mood disturbance, depression of psychosis, after temporal lobe surgery and only one after an extratemporal resection. In 20 (8%) of the TLE patients they were pre-existent, in 18 (7%) de novo. At four years follow-up the percentage of patients requiring special treatment had dropped to 6%. Medication: In a series of 145 patients in class 1 A+B medication was succesfully stopped in 27% and decreased in 33%. Decrease or stopping of medication was unsuccesful in 18%, respectively 4% with some patiens becoming permanently medically resistent.