The majority of patients are seizure-free five years after epilepsy surgery, according to a unique European collaborative study. Kuopio University Hospital Epilepsy Center and the Clinical Epilepsy Research Group at the University of Eastern Finland participated in the study investigating the outcome of epilepsy surgery in more than 9,000 individuals from 37 centres in 18 countries. The results were published in Lancet Neurology, the highest-ranked medical journal in the field of neuroscience.
The study was based on data obtained from the European Epilepsy Brain Bank and it was carried out within the European Reference Network (ERN) EpiCARE. This extensive collaboration enabled the researchers to determine precise and longitudinal seizure-freedom and medication-freedom rates in patients who were operated on between 2000 and 2012, up to 5 years following surgery. Never before have surgical outcomes been presented in such a large cohort, enabling outcome assessment for each of eleven epileptogenic pathology categories separately.
The study showed how successful epilepsy surgery is, with 72% of patients reaching seizure-freedom at one year, 68% at two, and 66% at five years following surgery. Outcomes were significantly determined by underlying pathology. Patients with tumours, vascular lesions and hippocampal sclerosis most often reached seizure-freedom (78%, 74% and 72% at 2 years, respectively), while those with no histopathological lesion, or with specific subtypes of malformation of cortical development, did worst (seizure-freedom rates 54% and 50%, respectively). After five years, 45% of children and 28% of adults had completely discontinued anti-seizure drugs. A longer duration of epilepsy – from first seizure to time of surgery – negatively affected the chance of reaching seizure-freedom.
This study convincingly demonstrates the success of epilepsy surgery, helps to counsel patients facing surgery about expected outcome rates, and further supports the notion that early epilepsy surgery improves outcome.
For further information, please contact:
Professor Reetta Kälviäinen reetta.kalviainen (at) uef.fi, tel. +358405839249
Article: Lamberink HJ, Otte WM, Blümcke I, et al. Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study. Lancet Neurol. 2020;19(9):748-757.