Long-term Epilepsy Surgery Success Helps Decisions

Long-term results of epilepsy surgery offer good information for patient counseling.

One-third of patients with hard-to-treat epilepsy who undergo brain surgery remain seizure-free for up to 15 years, and for three-fourths of these patients the results are favorable, according to a new study.

“These encouraging findings will be valuable during the decision-making process and counseling on different aspects of care in patients with epilepsy,” stated the researchers, led by Vibhangini S. Wasade, MD, of the Comprehensive Epilepsy Program, Department of Neurology, Henry Ford Hospital, in Detroit.

“Most previous studies looked at seizure and psychosocial outcomes at 2 to 5 years after surgery, and a few for up to 10 years. We aimed to assess the long-term outcomes-up to 15 years-at our epilepsy center,” he said.

Dr Wasade and colleagues conducted a telephone survey of 470 patients who had resective surgery to treat localization-related intractable epilepsy from 1993 to 2011 at Henry Ford Hospital. Fifty patients had died since their procedure. Among the remaining 420 patients, mean age 35 years at the time of surgery, the large majority (88%) were Caucasian.

Nearly two-thirds of the patients were contacted by telephone. The researchers chose phone surveys over mailed or in-person surveys because of the potential for a better response rate, especially given that a number of the patients may have moved out of the area or were no longer receiving care at the hospital.

After analyzing the survey responses, the researchers found that a large majority of patients (92%) considered epilepsy surgery worthwhile; 32% were seizure-free and 75% had favorable results. Most important, favorable and seizure-free outcome rates remained stable after surgery over long-term follow-up.

Compared with before surgery, patients at the time of the survey were more likely to be driving and more likely to be taking antidepressant medication but less likely to be working full time.

“We found that 35% of patients drove before surgery and 51% drove after their procedure-a statistically significant increase,” Dr Wasade said. “There also was a decrease in full-time employment status from before to after epilepsy surgery.” He explained that the surveyed patients were comparatively older and undergoing surgery at a later age.

About 7% of the patients were retired and 35% were not employed for reasons other than seizures, the researchers noted. The reasons included limited education and job training because of longstanding epilepsy and limited employment opportunities because of hard economic conditions at the time of the survey.

The researchers noted that the increase in antidepressant use found in the survey may indicate continuing depression symptoms present before surgery, other ongoing illness, depression as an adverse effect of antiepileptic drugs, or better clinical recognition of epilepsy-related depression when compared with past years.

“The assessment of long-term outcomes helps in defining the enduring effect of epilepsy surgery,” the researchers stated. “In the surveyed patients, rates for favorable seizure outcomes appear to have been sustained over time for up to two decades, indicating stable maintenance of long-term seizure outcomes.”

The researchers published their results in the February 2015 issue of Epilepsy & Behavior.