Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis

Aaron Cohen-Gadol, Brian G. Wilhelmi, Frederic Collignon, J. Bradley White, Jeffrey W. Britton, Denise M. Cambier, Teresa J H Christianson, W. Richard Marsh, Fredric B. Meyer, Gregory D. Cascino

Research output: Contribution to journalArticle

192 Citations (Scopus)

Abstract

Object. The authors reviewed the long-term outcome of focal resection in a large group of patients who had intractable partial nonlesional epilepsy, including mesial temporal lobe sclerosis (MTS), and who were treated consecutively at a single institution. The goal of this study was to evaluate the long-term efficacy of epilepsy surgery and the preoperative factors associated with seizure outcome. Methods. This retrospective analysis included 399 consecutive patients who underwent epilepsy surgery at Mayo Clinic in Rochester, Minnesota, between 1988 and 1996. The mean age of the patients at surgery was 32 ± 12 years (range 3-69 years), and the mean age at seizure onset was 12 ± 11 years (range 0-55 years). There were 214 female (54%) and 185 male (46%) patients. The mean duration of epilepsy was 20 ± 12 years (range 1-56 years). The preceding values are given as the mean ± standard deviation. Of the 399 patients, 237 (59%) had a history of complex partial seizures, 119 (30%) had generalized seizures, 26 (6%) had simple partial seizures, and 17 (4%) had experienced a combination of these. Preoperative evaluation included a routine and video-electroencephalography recordings, magnetic resonance imaging of the head according to the seizure protocol, neuropsychological testing, and a sodium amobarbital study. Patients with an undefined epileptogenic focus and discordant preoperative studies underwent an intracranial study. The mean duration of follow up was 6.2 ± 4.5 years (range 0.6-15.7 years). Seizure outcome was categorized based on the modified Engel classification. Time-to-event analysis was performed using Kaplan-Meier curves and Cox regression models to evaluate the risk factors associated with outcomes. Among these patients, 372 (93%) underwent temporal and 27 (7%) had extratemporal resection of their epileptogenic focus. Histopathological examination of the resected specimens revealed MTS in 113 patients (28%), gliosis 237 (59%), and normal findings in 49 (12%). Based on the Kaplan-Meier analysis, the probability of an Engel Class I outcome (seizure free, auras, or seizures related only to medication withdrawal) for the overall patient group was 81% (95% confidence interval [CI] 77-85%) at 6 months, 78% (CI 74-82%) at 1 year, 76% (CI 72-80%) at 2 years, 74% (CI 69-78%) at 5 years, and 72% (CI 67-77%) at 10 years postoperatively. The rate of Class I outcomes remained 72% for 73 patients with more than 10 years of follow up. If a patient was in Class I at 1 year postoperatively, the probability of seizure remission at 10 years postoperatively was 92% (95% CI 89-96%); almost all seizures occurred during the 1st year after surgery. Factors predictive of poor outcome from surgery were normal pathological findings resected tissue (p = 0.038), male sex (p = 0.035), previous surgery (p <0.001), and an extratemporal origin of seizures (p <0.001). Conclusions. The response to epilepsy surgery during the 1st follow-up year is a reliable indicator of the long-term Engel Class I postoperative outcome. This finding may have important implications for patient counseling and postoperative discontinuation of anticonvulsant medications.

Original languageEnglish (US)
Pages (from-to)513-524
Number of pages12
JournalJournal of Neurosurgery
Volume104
Issue number4
DOIs
StatePublished - Apr 1 2006
Externally publishedYes

Fingerprint

Sclerosis
Temporal Lobe
Epilepsy
Seizures
Confidence Intervals
Partial Epilepsy
Amobarbital
Video Recording
Gliosis
Kaplan-Meier Estimate
Age of Onset
Proportional Hazards Models
Anticonvulsants
Counseling
Electroencephalography
Head
Magnetic Resonance Imaging

Keywords

  • Epilepsy
  • Epilepsy surgery
  • Gliosis
  • Long-term outcome
  • Mesial temporal lobe sclerosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis. / Cohen-Gadol, Aaron; Wilhelmi, Brian G.; Collignon, Frederic; White, J. Bradley; Britton, Jeffrey W.; Cambier, Denise M.; Christianson, Teresa J H; Marsh, W. Richard; Meyer, Fredric B.; Cascino, Gregory D.

In: Journal of Neurosurgery, Vol. 104, No. 4, 01.04.2006, p. 513-524.

Research output: Contribution to journalArticle

Cohen-Gadol, A, Wilhelmi, BG, Collignon, F, White, JB, Britton, JW, Cambier, DM, Christianson, TJH, Marsh, WR, Meyer, FB & Cascino, GD 2006, 'Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis', Journal of Neurosurgery, vol. 104, no. 4, pp. 513-524. https://doi.org/10.3171/jns.2006.104.4.513
Cohen-Gadol, Aaron ; Wilhelmi, Brian G. ; Collignon, Frederic ; White, J. Bradley ; Britton, Jeffrey W. ; Cambier, Denise M. ; Christianson, Teresa J H ; Marsh, W. Richard ; Meyer, Fredric B. ; Cascino, Gregory D. / Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis. In: Journal of Neurosurgery. 2006 ; Vol. 104, No. 4. pp. 513-524.
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abstract = "Object. The authors reviewed the long-term outcome of focal resection in a large group of patients who had intractable partial nonlesional epilepsy, including mesial temporal lobe sclerosis (MTS), and who were treated consecutively at a single institution. The goal of this study was to evaluate the long-term efficacy of epilepsy surgery and the preoperative factors associated with seizure outcome. Methods. This retrospective analysis included 399 consecutive patients who underwent epilepsy surgery at Mayo Clinic in Rochester, Minnesota, between 1988 and 1996. The mean age of the patients at surgery was 32 ± 12 years (range 3-69 years), and the mean age at seizure onset was 12 ± 11 years (range 0-55 years). There were 214 female (54{\%}) and 185 male (46{\%}) patients. The mean duration of epilepsy was 20 ± 12 years (range 1-56 years). The preceding values are given as the mean ± standard deviation. Of the 399 patients, 237 (59{\%}) had a history of complex partial seizures, 119 (30{\%}) had generalized seizures, 26 (6{\%}) had simple partial seizures, and 17 (4{\%}) had experienced a combination of these. Preoperative evaluation included a routine and video-electroencephalography recordings, magnetic resonance imaging of the head according to the seizure protocol, neuropsychological testing, and a sodium amobarbital study. Patients with an undefined epileptogenic focus and discordant preoperative studies underwent an intracranial study. The mean duration of follow up was 6.2 ± 4.5 years (range 0.6-15.7 years). Seizure outcome was categorized based on the modified Engel classification. Time-to-event analysis was performed using Kaplan-Meier curves and Cox regression models to evaluate the risk factors associated with outcomes. Among these patients, 372 (93{\%}) underwent temporal and 27 (7{\%}) had extratemporal resection of their epileptogenic focus. Histopathological examination of the resected specimens revealed MTS in 113 patients (28{\%}), gliosis 237 (59{\%}), and normal findings in 49 (12{\%}). Based on the Kaplan-Meier analysis, the probability of an Engel Class I outcome (seizure free, auras, or seizures related only to medication withdrawal) for the overall patient group was 81{\%} (95{\%} confidence interval [CI] 77-85{\%}) at 6 months, 78{\%} (CI 74-82{\%}) at 1 year, 76{\%} (CI 72-80{\%}) at 2 years, 74{\%} (CI 69-78{\%}) at 5 years, and 72{\%} (CI 67-77{\%}) at 10 years postoperatively. The rate of Class I outcomes remained 72{\%} for 73 patients with more than 10 years of follow up. If a patient was in Class I at 1 year postoperatively, the probability of seizure remission at 10 years postoperatively was 92{\%} (95{\%} CI 89-96{\%}); almost all seizures occurred during the 1st year after surgery. Factors predictive of poor outcome from surgery were normal pathological findings resected tissue (p = 0.038), male sex (p = 0.035), previous surgery (p <0.001), and an extratemporal origin of seizures (p <0.001). Conclusions. The response to epilepsy surgery during the 1st follow-up year is a reliable indicator of the long-term Engel Class I postoperative outcome. This finding may have important implications for patient counseling and postoperative discontinuation of anticonvulsant medications.",
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author = "Aaron Cohen-Gadol and Wilhelmi, {Brian G.} and Frederic Collignon and White, {J. Bradley} and Britton, {Jeffrey W.} and Cambier, {Denise M.} and Christianson, {Teresa J H} and Marsh, {W. Richard} and Meyer, {Fredric B.} and Cascino, {Gregory D.}",
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TY - JOUR

T1 - Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis

AU - Cohen-Gadol, Aaron

AU - Wilhelmi, Brian G.

AU - Collignon, Frederic

AU - White, J. Bradley

AU - Britton, Jeffrey W.

AU - Cambier, Denise M.

AU - Christianson, Teresa J H

AU - Marsh, W. Richard

AU - Meyer, Fredric B.

AU - Cascino, Gregory D.

PY - 2006/4/1

Y1 - 2006/4/1

N2 - Object. The authors reviewed the long-term outcome of focal resection in a large group of patients who had intractable partial nonlesional epilepsy, including mesial temporal lobe sclerosis (MTS), and who were treated consecutively at a single institution. The goal of this study was to evaluate the long-term efficacy of epilepsy surgery and the preoperative factors associated with seizure outcome. Methods. This retrospective analysis included 399 consecutive patients who underwent epilepsy surgery at Mayo Clinic in Rochester, Minnesota, between 1988 and 1996. The mean age of the patients at surgery was 32 ± 12 years (range 3-69 years), and the mean age at seizure onset was 12 ± 11 years (range 0-55 years). There were 214 female (54%) and 185 male (46%) patients. The mean duration of epilepsy was 20 ± 12 years (range 1-56 years). The preceding values are given as the mean ± standard deviation. Of the 399 patients, 237 (59%) had a history of complex partial seizures, 119 (30%) had generalized seizures, 26 (6%) had simple partial seizures, and 17 (4%) had experienced a combination of these. Preoperative evaluation included a routine and video-electroencephalography recordings, magnetic resonance imaging of the head according to the seizure protocol, neuropsychological testing, and a sodium amobarbital study. Patients with an undefined epileptogenic focus and discordant preoperative studies underwent an intracranial study. The mean duration of follow up was 6.2 ± 4.5 years (range 0.6-15.7 years). Seizure outcome was categorized based on the modified Engel classification. Time-to-event analysis was performed using Kaplan-Meier curves and Cox regression models to evaluate the risk factors associated with outcomes. Among these patients, 372 (93%) underwent temporal and 27 (7%) had extratemporal resection of their epileptogenic focus. Histopathological examination of the resected specimens revealed MTS in 113 patients (28%), gliosis 237 (59%), and normal findings in 49 (12%). Based on the Kaplan-Meier analysis, the probability of an Engel Class I outcome (seizure free, auras, or seizures related only to medication withdrawal) for the overall patient group was 81% (95% confidence interval [CI] 77-85%) at 6 months, 78% (CI 74-82%) at 1 year, 76% (CI 72-80%) at 2 years, 74% (CI 69-78%) at 5 years, and 72% (CI 67-77%) at 10 years postoperatively. The rate of Class I outcomes remained 72% for 73 patients with more than 10 years of follow up. If a patient was in Class I at 1 year postoperatively, the probability of seizure remission at 10 years postoperatively was 92% (95% CI 89-96%); almost all seizures occurred during the 1st year after surgery. Factors predictive of poor outcome from surgery were normal pathological findings resected tissue (p = 0.038), male sex (p = 0.035), previous surgery (p <0.001), and an extratemporal origin of seizures (p <0.001). Conclusions. The response to epilepsy surgery during the 1st follow-up year is a reliable indicator of the long-term Engel Class I postoperative outcome. This finding may have important implications for patient counseling and postoperative discontinuation of anticonvulsant medications.

AB - Object. The authors reviewed the long-term outcome of focal resection in a large group of patients who had intractable partial nonlesional epilepsy, including mesial temporal lobe sclerosis (MTS), and who were treated consecutively at a single institution. The goal of this study was to evaluate the long-term efficacy of epilepsy surgery and the preoperative factors associated with seizure outcome. Methods. This retrospective analysis included 399 consecutive patients who underwent epilepsy surgery at Mayo Clinic in Rochester, Minnesota, between 1988 and 1996. The mean age of the patients at surgery was 32 ± 12 years (range 3-69 years), and the mean age at seizure onset was 12 ± 11 years (range 0-55 years). There were 214 female (54%) and 185 male (46%) patients. The mean duration of epilepsy was 20 ± 12 years (range 1-56 years). The preceding values are given as the mean ± standard deviation. Of the 399 patients, 237 (59%) had a history of complex partial seizures, 119 (30%) had generalized seizures, 26 (6%) had simple partial seizures, and 17 (4%) had experienced a combination of these. Preoperative evaluation included a routine and video-electroencephalography recordings, magnetic resonance imaging of the head according to the seizure protocol, neuropsychological testing, and a sodium amobarbital study. Patients with an undefined epileptogenic focus and discordant preoperative studies underwent an intracranial study. The mean duration of follow up was 6.2 ± 4.5 years (range 0.6-15.7 years). Seizure outcome was categorized based on the modified Engel classification. Time-to-event analysis was performed using Kaplan-Meier curves and Cox regression models to evaluate the risk factors associated with outcomes. Among these patients, 372 (93%) underwent temporal and 27 (7%) had extratemporal resection of their epileptogenic focus. Histopathological examination of the resected specimens revealed MTS in 113 patients (28%), gliosis 237 (59%), and normal findings in 49 (12%). Based on the Kaplan-Meier analysis, the probability of an Engel Class I outcome (seizure free, auras, or seizures related only to medication withdrawal) for the overall patient group was 81% (95% confidence interval [CI] 77-85%) at 6 months, 78% (CI 74-82%) at 1 year, 76% (CI 72-80%) at 2 years, 74% (CI 69-78%) at 5 years, and 72% (CI 67-77%) at 10 years postoperatively. The rate of Class I outcomes remained 72% for 73 patients with more than 10 years of follow up. If a patient was in Class I at 1 year postoperatively, the probability of seizure remission at 10 years postoperatively was 92% (95% CI 89-96%); almost all seizures occurred during the 1st year after surgery. Factors predictive of poor outcome from surgery were normal pathological findings resected tissue (p = 0.038), male sex (p = 0.035), previous surgery (p <0.001), and an extratemporal origin of seizures (p <0.001). Conclusions. The response to epilepsy surgery during the 1st follow-up year is a reliable indicator of the long-term Engel Class I postoperative outcome. This finding may have important implications for patient counseling and postoperative discontinuation of anticonvulsant medications.

KW - Epilepsy

KW - Epilepsy surgery

KW - Gliosis

KW - Long-term outcome

KW - Mesial temporal lobe sclerosis

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