Long-term results of treatment of pharmacoresistant temporal lobe epilepsy
https://doi.org/10.17650/1683-3295-2021-23-3-23-29
Abstract
The aim of the study wasto evaluate the long-term results ofsurgicaltreatment of patients with pharmacoresistant epilepsy.
Materials and methods. A retrospective analysis of treatment outcomes in patients with drug-resistant temporal lobe epilepsy was performed. According to the inclusion and exclusion criteria, 96 patients were selected for the study. Group 1 contained 49 operated patients with MR-positive epilepsy and Group 2 contained 47 operated patients with MR-ne‑ gative epilepsy. The control group consisted of 53 unoperated patients. The outcomes ofsurgical treatment were assessed after 6, 12, and 24 months. Results. Unfavorable outcomes occurred more frequently among nonoperated patients compared to both surgical groups (p <0.001). The probability of the 2-year remission after surgery in operated MRI positive patients was 60 %, in MRI negative group was 45 %, and in conservative group – only 2 %. The mean duration of the seizures-free period was greatest̆in the MRI positive surgical group (15.4 ± 1.5 months), and shortest in the control group (3.3 ± 0.9 months).
Conclusion. The presented results prove the effectiveness and safety of surgical treatment of patients with temporal lobe epilepsy.
About the Authors
V. V. KrylovRussian Federation
Bld. 1, 20 Delegatskaya St., Moscow 127473,
3 Bolshaya Sukharevskaya Sq., Moscow 129090
A. B. Gekht
Russian Federation
43 Donskaya St., Moscow 115419
I. S. Trifonov
Russian Federation
Bld. 1, 20 Delegatskaya St., Moscow 127473
O. O. Kordonskaya
Russian Federation
Olga O. Kordonskaya
3 Bolshaya Sukharevskaya Sq., Moscow 129090,
Bld. 10, 1 Ostrovityanova St., Moscow 117977
M. V. Sinkin
Russian Federation
Bld. 1, 20 Delegatskaya St., Moscow 127473,
3 Bolshaya Sukharevskaya Sq., Moscow 129090
References
1. Behr C., Goltzene M.A., Kosmalski G. et al. Epidemiology of epilepsy. Rev Neurol 2016;172(1):27–36. DOI: 10.1016/j.neurol.2015.11.003.
2. Picot M.C., Baldy-Moulinier M., Daurès J.P. et al. The prevalence of epilepsy and pharmacoresistant epilepsy in adults: a population-based study in a Western European country. Epilepsia 2008;49(7):1230–8. DOI: 10.1111/j.1528-1167.2008.01579.x.
3. Kwan P., Brodie M.J. Early identification of refractory epilepsy. N Eng J Med 2000;342(5):314–9. DOI: 10.1056/NEJM200002033420503.
4. Kwan P., Schachter S.C., Brodie M.J. Drug-resistant epilepsy. N Eng J Med 2011;365(10):919–26. DOI: 10.1056/NEJMra1004418.
5. Begley C.E., Famulari M., Annegers J.F. et al. The cost of epilepsy in the United States: an estimate from populationbased clinical and survey data. Epilepsia 2000;41(3):342–51. DOI: 10.1111/j.1528-1157.2000. tb00166.x.
6. Wiebe S., Blume W.T., Girvin J.P. et al. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Eng J Med 2001;345(5):311–8. DOI: 10.1056/NEJM200108023450501.
7. Engel J., McDermott M.P., Wiebe S. et al. Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA 2012;307(9):922–30. DOI: 10.1001/jama.2012.220.
8. Krylov V.V. Epilepsy surgery. Moscow: ABV-press, 2019. 408 p. (In Russ.).
9. Krylov V.V., Gekht A.B., Trifonov I.S. et al. Outcomes of surgical treatment of patients with pharmacoresistant epilepsy. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry 2016;116(9–2):13–8. (In Russ.). DOI: 10.17116/jnevro20161169213-18.
10. Spencer S.S., Berg A.T., Vickrey B.G. et al. Predicting long-term seizure outcome after resective epilepsy surgery the multicenter study. Neurology 2005;65(6):912–8. DOI: 10.1212/01.wnl.0000176055.45774.71.
11. Téllez-Zenteno J.F., Dhar R., Wiebe S. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Brain 2005;128(5):1188–98. DOI: 10.1093/brain/awh449.
12. Salanova V., Markand O., Worth R. Temporal lobe epilepsy surgery: outcome, complications, and late mortality rate in 215 patients. Epilepsia 2002;43(2):170–4. DOI: 10.1046/j.1528-1157.2002.33800.x.
13. Berg A.T. Defining intractable epilepsy. Adv Neurol 2006;97:5–10.
14. Blümcke I., Thom M., Aronica E. et al. The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc task force of the ILAE Diagnostic Methods Commission. Epilepsia 2011;52(1):158–74. DOI: 10.1111/j.1528-1167.2010.02777.x.
15. Wieser H.G., Blume W.T., Fish D. et al. Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia 2001;42(2):282–6.
16. Liu J., Liu B., Zhang H. Surgical versus medical treatment of drug-resistant epilepsy: A systematic review and metaanalysis. Epilepsy Behav 2018;82:179–88. DOI: 10.1016/j.yebeh.2017.11.012.
17. Berg A.T., Langfitt J., Shinnar S. et al. How long does it take for partial epilepsy to become intractable? Neurology 2003;60(2):186–90. DOI: 10.1212/01.wnl.0000031792.89992.ec.
18. Lowe N.M., Eldridge P., Varma T., Wieshmann U.C. The duration of temporal lobe epilepsy and seizure outcome after epilepsy surgery. Seizure 2010;19(5):261–3. DOI: 10.1016/j.seizure.2010.02.011.
19. Janszky J., Janszky I., Schulz R. et al. Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome. Brain 2005;128(2):395–404. DOI: 10.1093/brain/awh358.
20. Berg A.T. Understanding the delay before epilepsy surgery: who develops intractable focal epilepsy and when? CNS Spectr 2004;9(2):136–44. DOI: 10.1017/s109285290000849x.
21. Korinek A.M., Golmard J.L., Elcheick A. et al. Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4578 patients. Br J Neurosurg 2005;19(2):155–62. DOI: 10.1080/02688690500145639.
22. Hader W.J., Tellez-Zenteno J., Metcalfe A. et al. Complications of epilepsy surgery: a systematic review of focal surgical resections and invasive EEG monitoring. Epilepsia 2013;54(5):840–7. DOI: 10.1111/epi.12161.
23. Beisse F., Lagrèze W.A., Schmitz J., Schulze-Bonhage A. Visual field defects after epilepsy surgery: Implications for driving license tenure. Ophthalmologe 2014;111(10):942–7. DOI: 10.1007/s00347-013-3013-9.
24. Lawn N.D., Bamlet W.R., Radhakrishnan K. et al. Injuries due to seizures in persons with epilepsy: a population-based study. Neurology 2004;63(9):1565–70. DOI: 10.1212/01.wnl.0000142991.14507.b5.
25. Beghi E., Cornaggia C., RESt‐1 Group. Morbidity and accidents in patients with epilepsy: results of a European cohort study. Epilepsia 2002;43(9):1076–83. DOI: 10.1046/j.1528-1157.2002.18701.x.
26. Friedman D.E., Gilliam F.G. Seizurerelated injuries are underreported in pharmacoresistant localization-related epilepsy. Epilepsia 2010;51(1):43–7. DOI: 10.1111/j.1528-1167.2009.02170.x.
27. Tomson T., Beghi E., Sundqvist A., Johannessen S.I. Medical risks in epilepsy: a review with focus on physical injuries, mortality, traffic accidents and their prevention. Epilepsy Res 2004;60(1):1–16. DOI: 10.1016/j.eplepsyres.2004.05.004.
28. Nilsson L., Ahlbom A., Farahmand B.Y., Tomson T. Mortality in a populationbased cohort of epilepsy surgery patients. Epilepsia 2003;44(4):575–81. DOI: 10.1046/j.1528-1157.2003.03302.x.
29. Tomson T., Nashef L., Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions. Lancet Neurol 2008;7(11):1021–31. DOI: 10.1016/S1474-4422(08)70202-3.
30. Boylan L.S., Flint L.A., Labovitz D.L. et al. Depression but not seizure frequency predicts quality of life in treatmentresistant epilepsy. Neurology 2004;62(2):258–61. DOI: 10.1212/01.wnl.0000103282.62353.85.
31. Wiebe S. Early epilepsy surgery. Curr Neurol Neurosci Rep 2004;4(4):315–20. DOI: 10.1007/s11910-004-0058-9.
Review
For citations:
Krylov V.V., Gekht A.B., Trifonov I.S., Kordonskaya O.O., Sinkin M.V. Long-term results of treatment of pharmacoresistant temporal lobe epilepsy. Russian journal of neurosurgery. 2021;23(3):23-29. (In Russ.) https://doi.org/10.17650/1683-3295-2021-23-3-23-29