Outcomes of Epilepsy Surgery: Early Results of a Multicenter Study
Abstract number :
2.315
Submission category :
Year :
2001
Submission ID :
365
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
S.S. Spencer, MD, Neurology, Yale University School of Medicine, New Haven, CT; A.T. Berg, PhD, Biological Sciences, Northern Illinois University, DeKalb, IL; B.G. Vickrey, MD,MPH, Neurology, University of California, Los Angeles, Los Angeles, CA; M.R. Sp
RATIONALE: Large contemporary series of resective epilepsy surgery are needed to examine seizure and health-related quality of life outcomes.
METHODS: 368 patients were enrolled to be assessed with standardized pre and postoperative measures of seizure frequency, health-related quality of life (HRQOL), psychiatric status, and neurologic function as part of a 7 center, prospective, observational study of outcomes of resective epilepsy surgery. Of those, we identified the patients who had at least two year postoperative followup and had completed HRQOL, anxiety, depression, and seizure data at 24 months followup and at baseline. We report initial results of seizure remission and relapse and its relation to HRQOL, anxiety, and depression in patients followed at least two years post surgery.
RESULTS: Of the enrolled patients, 149 had at least two years (up to 4 years) postoperative followup and fulfilled the criteria for this early analysis. 74/149 (50%) patients had an immediate 1 year remission, and an additional 30 patients remitted by 3 years after surgery. The cumulative probability of one-year remission was 50% at 1 year, 66% at 2 years, and 70% at 3 years after surgery. Relapses occurred in 21 patients after they achieved remission. The cumulative risk of relapse was 12%, 17% and 37% at 1,2,and 3 years after achieving remission. HRQOL, anxiety and depression all improved 3 months after surgery and further improved by 1 year after surgery in seizure-free patients. Patients with continued seizures saw HRQOL and anxiety scores return to baseline levels, while depression scores worsened beyond baseline levels. Employment did not change significantly, regardless of seizure outcome.
CONCLUSIONS: When resective epilepsy surgery controls seizures, substantial improvements in HRQOL, anxiety and depression are seen. Longer followup and greater numbers are needed to define predictive factors for various outcomes. Worsening of some outcomes after unsuccessful epilepsy surgery is a concern.
Support: NIH-NINDS RO1-32375.