Initial outcomes in the Multicenter Study of Epilepsy Surgery

Susan S. Spencer, A. T. Berg, B. G. Vickrey, M. R. Sperling, C. W. Bazil, Shlomo Shinnar, J. T. Langfitt, T. S. Walczak, S. V. Pacia, N. Ebrahimi, D. Frobish

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

Objective: To obtain prospective data regarding seizures, anxiety, depression, and quality of life (QOL) outcomes after resective epilepsy surgery. Methods: The authors characterized resective epilepsy surgery patients prospectively at yearly intervals for seizure outcome, QOL, anxiety, and depression, using standardized instruments and patient interviews. Results: Of 396 patients who underwent resective surgical procedures, 355 were followed for at least 1 year. Of these, 75% achieved a 1-year remission at some time during follow-up; patients with medial temporal (77%) were more likely than neocortical resections (56%) to achieve remission (p = 0.01). Relapse occurred in 59 (22%) patients who remitted, more often in medial temporal (24%) than neocortical (4%) resected patients (p = 0.02). QOL, anxiety, and depression all improved dramatically within 3 months after surgery (p < 0.0001), with no significant difference based on seizure outcome. After 3 months, QOL in seizure-free patients further improved gradually, and patients with seizures showed gradual declines. By 12 and 24 months, overall QOL and its epilepsy-targeted and physical health domains were significantly different in the two outcome groups. (Anxiety and depression scores also gradually diverged, with improvements in seizure-free and declines in continued seizure groups, but differences were not significant.) Conclusion: Resective surgery for treatment of epilepsy significantly reduces seizures, most strikingly after medial temporal resection (77% 1 year remission) compared to neocortical resection (56% 1 year remission). Resective epilepsy surgery has a gradual but lasting effect on QOL, but minimal effects on anxiety and depression. Longer follow-up will be essential to determine ultimate seizure, QOL, and psychiatric outcomes of epilepsy surgery.

Original languageEnglish (US)
Pages (from-to)1680-1685
Number of pages6
JournalNeurology
Volume61
Issue number12
StatePublished - Dec 23 2003

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Multicenter Studies
Epilepsy
Seizures
Quality of Life
Anxiety
Depression
Psychiatry
Interviews
Recurrence
Health

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Spencer, S. S., Berg, A. T., Vickrey, B. G., Sperling, M. R., Bazil, C. W., Shinnar, S., ... Frobish, D. (2003). Initial outcomes in the Multicenter Study of Epilepsy Surgery. Neurology, 61(12), 1680-1685.

Initial outcomes in the Multicenter Study of Epilepsy Surgery. / Spencer, Susan S.; Berg, A. T.; Vickrey, B. G.; Sperling, M. R.; Bazil, C. W.; Shinnar, Shlomo; Langfitt, J. T.; Walczak, T. S.; Pacia, S. V.; Ebrahimi, N.; Frobish, D.

In: Neurology, Vol. 61, No. 12, 23.12.2003, p. 1680-1685.

Research output: Contribution to journalArticle

Spencer, SS, Berg, AT, Vickrey, BG, Sperling, MR, Bazil, CW, Shinnar, S, Langfitt, JT, Walczak, TS, Pacia, SV, Ebrahimi, N & Frobish, D 2003, 'Initial outcomes in the Multicenter Study of Epilepsy Surgery', Neurology, vol. 61, no. 12, pp. 1680-1685.
Spencer SS, Berg AT, Vickrey BG, Sperling MR, Bazil CW, Shinnar S et al. Initial outcomes in the Multicenter Study of Epilepsy Surgery. Neurology. 2003 Dec 23;61(12):1680-1685.
Spencer, Susan S. ; Berg, A. T. ; Vickrey, B. G. ; Sperling, M. R. ; Bazil, C. W. ; Shinnar, Shlomo ; Langfitt, J. T. ; Walczak, T. S. ; Pacia, S. V. ; Ebrahimi, N. ; Frobish, D. / Initial outcomes in the Multicenter Study of Epilepsy Surgery. In: Neurology. 2003 ; Vol. 61, No. 12. pp. 1680-1685.
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abstract = "Objective: To obtain prospective data regarding seizures, anxiety, depression, and quality of life (QOL) outcomes after resective epilepsy surgery. Methods: The authors characterized resective epilepsy surgery patients prospectively at yearly intervals for seizure outcome, QOL, anxiety, and depression, using standardized instruments and patient interviews. Results: Of 396 patients who underwent resective surgical procedures, 355 were followed for at least 1 year. Of these, 75{\%} achieved a 1-year remission at some time during follow-up; patients with medial temporal (77{\%}) were more likely than neocortical resections (56{\%}) to achieve remission (p = 0.01). Relapse occurred in 59 (22{\%}) patients who remitted, more often in medial temporal (24{\%}) than neocortical (4{\%}) resected patients (p = 0.02). QOL, anxiety, and depression all improved dramatically within 3 months after surgery (p < 0.0001), with no significant difference based on seizure outcome. After 3 months, QOL in seizure-free patients further improved gradually, and patients with seizures showed gradual declines. By 12 and 24 months, overall QOL and its epilepsy-targeted and physical health domains were significantly different in the two outcome groups. (Anxiety and depression scores also gradually diverged, with improvements in seizure-free and declines in continued seizure groups, but differences were not significant.) Conclusion: Resective surgery for treatment of epilepsy significantly reduces seizures, most strikingly after medial temporal resection (77{\%} 1 year remission) compared to neocortical resection (56{\%} 1 year remission). Resective epilepsy surgery has a gradual but lasting effect on QOL, but minimal effects on anxiety and depression. Longer follow-up will be essential to determine ultimate seizure, QOL, and psychiatric outcomes of epilepsy surgery.",
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AU - Berg, A. T.

AU - Vickrey, B. G.

AU - Sperling, M. R.

AU - Bazil, C. W.

AU - Shinnar, Shlomo

AU - Langfitt, J. T.

AU - Walczak, T. S.

AU - Pacia, S. V.

AU - Ebrahimi, N.

AU - Frobish, D.

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N2 - Objective: To obtain prospective data regarding seizures, anxiety, depression, and quality of life (QOL) outcomes after resective epilepsy surgery. Methods: The authors characterized resective epilepsy surgery patients prospectively at yearly intervals for seizure outcome, QOL, anxiety, and depression, using standardized instruments and patient interviews. Results: Of 396 patients who underwent resective surgical procedures, 355 were followed for at least 1 year. Of these, 75% achieved a 1-year remission at some time during follow-up; patients with medial temporal (77%) were more likely than neocortical resections (56%) to achieve remission (p = 0.01). Relapse occurred in 59 (22%) patients who remitted, more often in medial temporal (24%) than neocortical (4%) resected patients (p = 0.02). QOL, anxiety, and depression all improved dramatically within 3 months after surgery (p < 0.0001), with no significant difference based on seizure outcome. After 3 months, QOL in seizure-free patients further improved gradually, and patients with seizures showed gradual declines. By 12 and 24 months, overall QOL and its epilepsy-targeted and physical health domains were significantly different in the two outcome groups. (Anxiety and depression scores also gradually diverged, with improvements in seizure-free and declines in continued seizure groups, but differences were not significant.) Conclusion: Resective surgery for treatment of epilepsy significantly reduces seizures, most strikingly after medial temporal resection (77% 1 year remission) compared to neocortical resection (56% 1 year remission). Resective epilepsy surgery has a gradual but lasting effect on QOL, but minimal effects on anxiety and depression. Longer follow-up will be essential to determine ultimate seizure, QOL, and psychiatric outcomes of epilepsy surgery.

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