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October 01, 2013; 81 (14) Article

Long-term outcomes of epilepsy surgery in Sweden

A national prospective and longitudinal study

Anna Edelvik, Bertil Rydenhag, Ingrid Olsson, Roland Flink, Eva Kumlien, Kristina Källén, Kristina Malmgren
First published August 21, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182a6ca7b
Anna Edelvik
From the Epilepsy Research Group, Institute of Neuroscience and Physiology (A.E., B.R., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University; Departments of Clinical Neurophysiology (R.F.) and Neurology (E.K.), Uppsala University Hospital; and Department of Neurology (K.K.), Institution of Clinical Neurosciences, Lund University, Sweden.
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Bertil Rydenhag
From the Epilepsy Research Group, Institute of Neuroscience and Physiology (A.E., B.R., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University; Departments of Clinical Neurophysiology (R.F.) and Neurology (E.K.), Uppsala University Hospital; and Department of Neurology (K.K.), Institution of Clinical Neurosciences, Lund University, Sweden.
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Ingrid Olsson
From the Epilepsy Research Group, Institute of Neuroscience and Physiology (A.E., B.R., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University; Departments of Clinical Neurophysiology (R.F.) and Neurology (E.K.), Uppsala University Hospital; and Department of Neurology (K.K.), Institution of Clinical Neurosciences, Lund University, Sweden.
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Roland Flink
From the Epilepsy Research Group, Institute of Neuroscience and Physiology (A.E., B.R., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University; Departments of Clinical Neurophysiology (R.F.) and Neurology (E.K.), Uppsala University Hospital; and Department of Neurology (K.K.), Institution of Clinical Neurosciences, Lund University, Sweden.
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Eva Kumlien
From the Epilepsy Research Group, Institute of Neuroscience and Physiology (A.E., B.R., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University; Departments of Clinical Neurophysiology (R.F.) and Neurology (E.K.), Uppsala University Hospital; and Department of Neurology (K.K.), Institution of Clinical Neurosciences, Lund University, Sweden.
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Kristina Källén
From the Epilepsy Research Group, Institute of Neuroscience and Physiology (A.E., B.R., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University; Departments of Clinical Neurophysiology (R.F.) and Neurology (E.K.), Uppsala University Hospital; and Department of Neurology (K.K.), Institution of Clinical Neurosciences, Lund University, Sweden.
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Kristina Malmgren
From the Epilepsy Research Group, Institute of Neuroscience and Physiology (A.E., B.R., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University; Departments of Clinical Neurophysiology (R.F.) and Neurology (E.K.), Uppsala University Hospital; and Department of Neurology (K.K.), Institution of Clinical Neurosciences, Lund University, Sweden.
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Citation
Long-term outcomes of epilepsy surgery in Sweden
A national prospective and longitudinal study
Anna Edelvik, Bertil Rydenhag, Ingrid Olsson, Roland Flink, Eva Kumlien, Kristina Källén, Kristina Malmgren
Neurology Oct 2013, 81 (14) 1244-1251; DOI: 10.1212/WNL.0b013e3182a6ca7b

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Abstract

Objective: To investigate prospective, population-based long-term outcomes concerning seizures and antiepileptic drug (AED) treatment after resective epilepsy surgery in Sweden.

Methods: Ten- and 5-year follow-ups were performed in 2005 to 2007 for 278/327 patients after resective epilepsy surgery from 1995 to 1997 and 2000 to 2002, respectively. All patients had been prospectively followed in the Swedish National Epilepsy Surgery Register. Ninety-three patients, who were presurgically evaluated but not operated, served as controls.

Results: In the long term (mean 7.6 years), 62% of operated adults and 50% of operated children were seizure-free, compared to 14% of nonoperated adults (p < 0.001) and 38% of nonoperated children (not significant). Forty-one percent of operated adults and 44% of operated children had sustained seizure freedom since surgery, compared to none of the controls (p < 0.0005). Multivariate analysis identified ≥30 seizures/month at baseline and long epilepsy duration as negative predictors and positive MRI to be a positive predictor of long-term seizure-free outcome. Ten years after surgery, 86% of seizure-free children and 43% of seizure-free adults had stopped AEDs in the surgery groups compared to none of the controls (p < 0.0005).

Conclusions: This population-based, prospective study shows good long-term seizure outcomes after resective epilepsy surgery. The majority of the patients who are seizure-free after 5 and 10 years have sustained seizure freedom since surgery. Many patients who gain seizure freedom can successfully discontinue AEDs, more often children than adults.

Classification of evidence: This study provides Class III evidence that more patients are seizure-free and have stopped AED treatment in the long term after resective epilepsy surgery than nonoperated epilepsy patients.

GLOSSARY

AED=
antiepileptic drug;
AUC=
area under receiver operating characteristic curve;
CI=
confidence interval;
FLR=
frontal lobe resection;
HS=
hippocampal sclerosis;
ILAE=
International League Against Epilepsy;
OR=
odds ratio;
RCT=
randomized controlled trials;
SGTCS=
secondarily generalized tonic-clonic seizures;
SNESUR=
Swedish National Epilepsy Surgery Register;
TLR=
temporal lobe resection

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at www.neurology.org

  • Received December 26, 2012.
  • Accepted in final form July 2, 2013.
  • © 2013 American Academy of Neurology
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