Long-term seizure and psychosocial outcomes after resective surgery for intractable epilepsy

article i nfo Article history: Resective surgery is considered an effective treatment for refractory localization-related epilepsy. Most studies have reported seizure and psychosocial outcomes of 2-5 years postsurgery and a few up to 10 years. Our study aimedtoassesslong-term(upto15years)postsurgicalseizureandpsychosocialoutcomesatourepilepsycenter. The Henry Ford Health System Corporate Data Store was accessed to identify patients who had undergone sur- gical resection for localization-related epilepsy from 1993 to 2011. Demographics including age at epilepsy onset and surgery, seizure frequency before surgery, and pathology were gathered from electronic medical re- cords. Phone surveys were conducted from May 2012 to January 2013 to determine patients' current seizure fre- quency and psychosocial metrics including driving and employment status and use of antidepressants. Surgical outcomes were based on Engel's classification (classes I and II = favorable outcomes). McNemar's tests, chi- square tests, two sample t-tests, and Wilcoxon two sample tests were used to analyze the relationships of psy- chosocial and surgical outcomes with demographic and surgical characteristics. A total of 470 patients had resective epilepsy surgery, and of those, 50 (11%) had died since surgery. Of the remaining, 253 (60%) were contacted with mean follow-up of 10.6 ± 5.0 years (27% of patients had follow-up of 15 years or longer). Of the patients surveyed, 32% were seizure-free and 75% had a favorable outcome (classes I and II). Favorable out- comes had significant associations with temporal resection (78% temporal vs 58% extratemporal, p = 0.01) and when surgery was performed after scalp EEG only (85% vs 65%, p b 0.001). Most importantly, favorable and seizure-free outcome rates remained stable after surgery over long-term follow-up (i.e., b5 years (77%, 41%), 5-10 years (67%, 29%), 10-15 years (78%, 38%), and N15 years (78%, 26%)). Compared to before surgery, patients atthe time of the survey were morelikelytobedriving (51%vs 35%,pb 0.001) andusingantidepressants (30% vs 22%, p = 0.013) but less likely to be working full-time (23% vs 42%, p b 0.001). A large majority of patients (92%) considered epilepsy surgery worthwhile regardless of the resection site, and this was associated with favorable outcomes (favorable = 98% vs unfavorable = 74%, p b 0.001). The findings suggest that resective epilepsy sur- gery yields favorable long-term postoperative seizure and psychosocial outcomes.