Seizure Freedom After Epilepsy Surgery
Developmental Outcome After Epilepsy Surgery in Infancy
Seizure Freedom After Epilepsy Surgery
The large number of epilepsy surgeries performed at the Cleveland Clinic and the long duration of follow-up available on our patients, allowed us to recently conduct a study to accurately analyze our results. The study authors reviewed patients operated on between 1995 and 2003 in the Cleveland Clinic Epilepsy Center and applied modern statistical methods of analysis to identify the factors that determine how well patients respond to surgery. The results were very revealing.
Temporal Lobectomy:
In patients where medications fail to control seizures, a temporal lobectomy represents the most promising treatment option. It is actually the most common type of brain surgery performed to treat epilepsy.
In this recently published research, 371 epilepsy patients who underwent a temporal lobectomy at the Cleveland Clinic were followed up over more than a decade. This study allowed us to evaluate how well patients do in the long-term following surgery. Previously, data has only been available up to one or two years, as reported by other centers.
In the group of patients evaluated, 78% were completely seizure-free two years following surgery, 66% were seizure-free five years following surgery and more than 50% remained seizure-free more than a decade later. Previous studies conducted on similar patients have already shown that chances of controlling seizures with medications alone would have been as low as 4% if surgery was not performed. Our research therefore shows that temporal lobectomy is not only successful, but also has durable benefits.
Information obtained from this study gave us insight into the long-term consequences of surgery. For example, we found that outcome at one year following surgery was a very good predictor of long-term results: patients who were seizure-free at one year had more than a 60% chance of remaining seizure-free a decade later. We also learned that simple tests, like an EEG (brain wave test) performed as early as 6 months after surgery can predict the chances of future seizure control and therefore guide decisions on seizure drug usage following surgery.
Published by Lara Jehi, M.D.
View the complete, published Temporal Lobectomy research article. (PDF)
Frontal Lobectomy:
Recent research at the Cleveland Clinic Epilepsy Center identified specific patient characteristics that would increase the chance of success with brain surgery to treat Frontal Lobe Epilepsy up to 80%.
Traditionally, Frontal Lobe Epilepsy has been considered as one of the most challenging types of epilepsy. Patients usually have very frequent seizures and are often disabled by their condition. The origin of seizures is usually difficult to pinpoint on EEG and surgical treatment is often very delicate as there are multiple critical functions, such as language and motor control, in that part of the brain. Previous studies done in other major epilepsy centers mention successful outcomes in the 15%-80% range, but those have only followed small groups of patients for one to two years and as such, only provided short-term information.
As stated previously, we at the Cleveland Clinic Epilepsy Center were able to conduct research on a large group of patients for up to a 10 year follow-up period. Looking at patients who had a frontal lobectomy, about 56% were seizure-free one year after surgery and about 30% were still seizure-free more than five years later. However, patients who fulfill certain criteria, such as having restricted abnormalities on their EEG and MRI, did remarkably better: up to 80% were seizure-free one year following surgery, more than half remained seizure-free three years later and up to 40% were still seizure-free a decade following surgery. The research also allowed us to identify certain clues about long-term seizure outcomes following early signs identified as early as the first week after surgery.
The research recently published in the international neurological journal Brain will allow doctors to carefully select the best surgical candidates, and to provide long-term counseling based on scientific information.
View the complete, published Frontal Lobectomy research article. (PDF)
Developmental outcome after epilepsy surgery in infancy
Objectives:
Our goals were to determine the effect of epilepsy surgery in infants (<3 years of age) on development and describe factors associated with postoperative developmental outcome.
Methods:
We identified 50 infants among 251 consecutive pediatric patients (<18 years old) undergoing epilepsy surgery. Charts were reviewed for clinical data and neurodevelopmental testing with the Bayley Scales of Infant Development. A developmental quotient was calculated to compare scores of children at different ages.
Results:
Complete data were available on 24 of 50 infants. Surgeries included 14 hemispherectomies and 10 focal resections. Seventeen patients became seizure free; 5 patients had >90% seizure reduction, 1 had >50% seizure reduction, and 1 had no change. The developmental quotient indicated modest postoperative improvement of mental age. The preoperative and postoperative development quotients correlated well. Younger infants had a higher increase in developmental quotient after surgery. Patients with epileptic spasms were younger and had a lower developmental quotient at presentation, but increase in developmental quotient was higher in this subgroup.
Conclusions:
After surgery, seizure frequency and developmental quotient improved. Developmental status before surgery predicted developmental function after surgery. Patients who were operated on at younger age and with epileptic spasms showed the largest increase in developmental quotient after surgery.
View the complete, published Surgery in Infancy research article. (PDF)
