Long-term outcomes of epilepsy surgery in Sweden
A national prospective and longitudinal study
Abstract
Objective:
To investigate prospective, population-based long-term outcomes concerning seizures and antiepileptic drug (AED) treatment after resective epilepsy surgery in Sweden.
Methods:
Ten- and 5-year follow-ups were performed in 2005 to 2007 for 278/327 patients after resective epilepsy surgery from 1995 to 1997 and 2000 to 2002, respectively. All patients had been prospectively followed in the Swedish National Epilepsy Surgery Register. Ninety-three patients, who were presurgically evaluated but not operated, served as controls.
Results:
In the long term (mean 7.6 years), 62% of operated adults and 50% of operated children were seizure-free, compared to 14% of nonoperated adults (p < 0.001) and 38% of nonoperated children (not significant). Forty-one percent of operated adults and 44% of operated children had sustained seizure freedom since surgery, compared to none of the controls (p < 0.0005). Multivariate analysis identified ≥30 seizures/month at baseline and long epilepsy duration as negative predictors and positive MRI to be a positive predictor of long-term seizure-free outcome. Ten years after surgery, 86% of seizure-free children and 43% of seizure-free adults had stopped AEDs in the surgery groups compared to none of the controls (p < 0.0005).
Conclusions:
This population-based, prospective study shows good long-term seizure outcomes after resective epilepsy surgery. The majority of the patients who are seizure-free after 5 and 10 years have sustained seizure freedom since surgery. Many patients who gain seizure freedom can successfully discontinue AEDs, more often children than adults.
Classification of evidence:
This study provides Class III evidence that more patients are seizure-free and have stopped AED treatment in the long term after resective epilepsy surgery than nonoperated epilepsy patients.
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Supplementary Material
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Information & Authors
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© 2013 American Academy of Neurology.
Publication History
Received: December 26, 2012
Accepted: July 2, 2013
Published online: August 21, 2013
Published in print: October 1, 2013
Disclosure
A. Edelvik received speaker honoraria from UCB and Eisai. B. Rydenhag, I. Olsson, and R. Flink report no disclosures. E. Kumlien served on a scientific advisory board for GlaxoSmithKline. K. Källén served on scientific advisory boards for Eisai and GlaxoSmithKline. K. Malmgren served on an educational advisory board for UCB and has received speaker's honoraria from UCB. Go to Neurology.org for full disclosures.
Study Funding
Funded by grants from the Swedish Research Council (grant 521-2011-169), the Sahlgrenska Academy at Gothenburg University through the LUA/ALF agreement (grant ALFGBG137431), the Gothenburg Foundation for Neurological Research, the Gothenburg Medical Society, the Margaretahem Foundation, and an unconditional research grant from GlaxoSmithKline to Anna Edelvik.
Authors
Author Contributions
Dr. Edelvik has analyzed and interpreted the data and written the manuscript. Dr. Rydenhag has analyzed and interpreted the data and revised the manuscript. Dr Olsson has interpreted the data and revised the manuscript. Dr. Flink is manager of the Swedish Epilepsy Surgery Register and assisted with data analysis. Dr. Kumlien and Dr. Källén have analyzed and interpreted the data concerning the nonoperated controls. Dr. Malmgren has designed the study, interpreted data, and written the manuscript.
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