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September 26, 2005

Predicting long-term seizure outcome after resective epilepsy surgery
The Multicenter Study

September 27, 2005 issue
65 (6) 912-918

Abstract

Background: In a seven-center prospective observational study of resective epilepsy surgery, the authors examined probability and predictors of entering 2-year remission and the risk of subsequent relapse.
Methods: Patients aged 12 years and over were enrolled at time of referral for epilepsy surgery, and underwent standardized evaluation, treatment, and follow-up procedures. The authors defined seizure remission as 2 years completely seizure-free after hospital discharge with or without auras, and relapse as any seizures after 2-year remission. The authors examined type of surgery, seizure, clinical and demographic variables, and localization study results with respect to prediction of seizure remission or relapse, using χ2 and proportional hazards analysis.
Results: Of 396 operated patients, 339 were followed over 2 years, and 223 (66%) experienced 2-year remission, not significantly different between medial temporal (68%) and neocortical (50%) resections. In multivariable models, only absence of generalized tonic-clonic seizures and presence of hippocampal atrophy were significantly and independently associated with remission, and only in the medial temporal resection group. Fifty-five patients relapsed after 2-year remission, again not significantly different between medial temporal (25%) and neocortical (19%) resections. Only delay to remission predicted relapse, and only in medial temporal patients.
Conclusion: Hippocampal atrophy and a history of absence of generalized tonic clonic seizures were the sole predictors of 2-year remission, and only for medial temporal resections.

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Information & Authors

Information

Published In

Neurology®
Volume 65Number 6September 27, 2005
Pages: 912-918
PubMed: 16186534

Publication History

Published online: September 26, 2005
Published in print: September 27, 2005

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Authors

Affiliations & Disclosures

S. S. Spencer, MD
From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; and Department of Neurology (Dr. Pacia), New York University School of Medicine, New York, NY.
A. T. Berg, PhD
From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; and Department of Neurology (Dr. Pacia), New York University School of Medicine, New York, NY.
B. G. Vickrey, MD, MPH
From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; and Department of Neurology (Dr. Pacia), New York University School of Medicine, New York, NY.
M. R. Sperling, MD
From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; and Department of Neurology (Dr. Pacia), New York University School of Medicine, New York, NY.
C. W. Bazil, MD, PhD
From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; and Department of Neurology (Dr. Pacia), New York University School of Medicine, New York, NY.
S. Shinnar, MD, PhD
From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; and Department of Neurology (Dr. Pacia), New York University School of Medicine, New York, NY.
J. T. Langfitt, PhD
From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; and Department of Neurology (Dr. Pacia), New York University School of Medicine, New York, NY.
T. S. Walczak, MD
From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; and Department of Neurology (Dr. Pacia), New York University School of Medicine, New York, NY.
S. V. Pacia, MD
From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; and Department of Neurology (Dr. Pacia), New York University School of Medicine, New York, NY.
for The Multicenter Study of Epilepsy Surgery
From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; and Department of Neurology (Dr. Pacia), New York University School of Medicine, New York, NY.

Notes

Address correspondence and reprint requests to Dr. Susan S. Spencer, Yale School of Medicine, P.O. Box 208018, New Haven, CT 06520-8018; e-mail: [email protected]

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