Predicting long-term seizure outcome after resective epilepsy surgery: The multicenter study

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

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226 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)912-918
Number of pages7
JournalNeurology
Volume65
Issue number6
DOIs
StatePublished - Sep 27 2005

ASJC Scopus subject areas

  • Clinical Neurology

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    Spencer, S. S., Berg, A. T., Vickrey, B. G., Sperling, M. R., Bazil, C. W., Shinnar, S., Langfitt, J. T., Walczak, T. S., & Pacia, S. V. (2005). Predicting long-term seizure outcome after resective epilepsy surgery: The multicenter study. Neurology, 65(6), 912-918. https://doi.org/10.1212/01.wnl.0000176055.45774.71