Global Outcomes of Epilepsy Surgery in Drug-Resistant
Focal Epilepsy: A Longitudinal Survey
Jedsada Thaweepoksomboon MD*, Yotin Chinvarun MD, PhD*,
Siraruj Sakoolnamarka MD**, Chesda Udommongkol MD, PhD*, Pasiri Sithinamsuwan MD*
Affiliation :
* Division of Neurology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
** Division of Neurosurgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Objective : Epilepsy surgery has been established for treatment of drug-resistant focal epilepsy. We aimed to determine
long-term outcomes of epileptic surgery in various aspects including seizure outcome, quality of life, and psychosocial
consequences after surgery.
Material and Method: A single center, cross-sectional study was conducted. The patients with drug-resistant focal epilepsy
who underwent epileptic surgery for at least one year were recruited.
Results : Thirty-seven adult drug-resistant epilepsy patients after epileptic surgery were enrolled with an average follow-up
period of 5.8 years. Twenty-three (62.2%) had temporal lobe epilepsy (TLE) and 14 (37.8%) had neocortical epilepsy. Four
were (10.8%) compatible with lesional negative refractory epilepsy. Hippocampal sclerosis was the most common etiology
(45.9%), followed by focal cortical dysplasia/gliosis (21.6%) and brain tumor (21.6%). The three commonest postoperative
complications were any medical illnesses (18.9%), memory impairment (18.9%), and visual filed defect (13.5%).
Twenty patients (54.1%) had no complications. Seizure outcomes, employment status, quality of life, depression, frank
psychosis, and number of antiepileptic drug (AED) between pre- and post-surgical period (interviewing time) were compared.
Engel Class I (seizure freedom) was persistently achieved in 19 (51.4%) patients. There were nine (24.3%) patients in Engel
Class II, eight (21.6%) in Engel Class III, and one (2.7%) in Engel Class IV. Seizure outcome, quality of life, and self-assessment
were improved after epileptic surgery at any age groups, duration of epilepsy, epileptogenic zone, and side of operation. In
some subgroups, it was found that income was increased and number of AED was reduced. However, depression and frank
psychosis did not change the outcome. On self-assessment, global impression of change in memory showed 27% improvement
and 32.4% no change. For language and communication skills, 29.7% was improved but 21.6% was worsened.
Conclusion : In this longitudinal study, epilepsy surgery showed improvement in seizure control, quality of life, and some
neuropsychological aspects.
Keywords : Global outcome, Epilepsy surgery, Drug resistant focal epilepsy
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