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, Shlomo Shinnar, J. T. Langfitt, T. S. Walczak, S. V. Pacia

Research output: Contribution to journalArticle

221 Citations (Scopus)

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 χ 2 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

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Multicenter Studies
Epilepsy
Seizures
Recurrence
Atrophy
Observational Studies
Referral and Consultation
Demography
Prospective Studies

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., ... 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

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

In: Neurology, Vol. 65, No. 6, 27.09.2005, p. 912-918.

Research output: Contribution to journalArticle

Spencer, SS, Berg, AT, Vickrey, BG, Sperling, MR, Bazil, CW, Shinnar, S, Langfitt, JT, Walczak, TS & Pacia, SV 2005, 'Predicting long-term seizure outcome after resective epilepsy surgery: The multicenter study', Neurology, vol. 65, no. 6, pp. 912-918. https://doi.org/10.1212/01.wnl.0000176055.45774.71
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. / Predicting long-term seizure outcome after resective epilepsy surgery : The multicenter study. In: Neurology. 2005 ; Vol. 65, No. 6. pp. 912-918.
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AU - Sperling, M. R.

AU - Bazil, C. W.

AU - Shinnar, Shlomo

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AB - 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 χ 2 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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