Long–term outcomes of epilepsy surgery in adults

Abstract

Epilepsy surgery is an efficacious treatment for selected persons with drug–resistant focal epilepsy, rendering many seizure–free and others significantly improved. There is Class I evidence for short–term efficacy of epilepsy surgery from two randomized controlled studies of temporal lobe resection. In order for patients to make an informed decision about the treatment option of epilepsy surgery, they also need data on the probability of long–term remission or improvement. Long–term longitudinal observational studies are necessary in order to obtain valid outcome data. From a number of such studies the proportion of patients who have been continuously free from seizures with impairment of consciousness since resective surgery seems to be 40–50 % after 10 years while a higher proportion have been seizure–free at least a year at each time–point assessed. The best longitudinal data are in patients who have undergone temporal lobe resection and in whom the histopathology was mesial sclerosis, and in these patients the majority of relapses occur within five years. Whether this course is applicable to other resection types and pathologies is not clear. There is much less information on the longitudinal course in patients who have undergone other resection types and have other causes. For many resection types the numbers of patients in single–centre long–term follow–ups is limited and for almost all studies there is a lack of controls. Multicentre observational studies following both operated and non–operated patients are needed in order to obtain more robust data.