Long-Term Outcomes of Epilepsy Surgery in Adults and Children (original) (raw)
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Epilepsy Surgery -A Short Update Review Article
Epilepsy surgery has been rapidly progressing over the last decade or so, with many previously untreatable conditions now satisfactorily managed to allow improved quality of life and seizure control without excessive medication and debilitating neurological deficits. We present a brief recap on accepted axioms of epilepsy surgery with a look at the future with a short summary of seizure disorder itself and the various management options.
Journal of Korean Neurosurgical Society, 2008
Objective : There are a few reports on the complications of surgery for epilepsy. We surveyed our data to present complications of epilepsy surgeries from the neurosurgeon's point of view and compare our results with other previous reports. Methods : A total of 179 surgical procedures for intractable epilepsy (41 diagnostic, 138 therapeutic) were performed in 92 consecutive patients (10 adults, 82 children) during the last 9.2 years (February. 1997-April. 2006). Their medical records and radiological findings were reviewed to identify and analyze the surgical complications. Results : The diagnostic procedures encompassed various combinations of subdural grid, subdural strips, and depth electrodes. Four minor transient complications developed in 41 diagnostic procedures (4/41=9.8%). A total of 138 therapeutic procedures included 28 anterior temporal lobectomies, 21 other lobectomies, 6 lesionectomies, 21 topectomies, 13 callosotomies, 20 vagus nerve stimulations, 13 multiple subpial transections, and 16 hemispherectomies. Twenty-six complications developed in therapeutic procedures (26/138=18.8%). Out of the 26 complications, 21 complications were transient and reversible (minor; 21/138=15.2%), and 5 were serious complications (major; 5/138=3.6%). Five major complications were one visual field defect, two mortality cases and two vegetative states. There were 2 additional mortality cases which were not related to the surgery itself. Conclusion : Our results indicate that complication rate was higher than previous other reports in minor complications and was comparable in major complications. However, our results show relatively high frequency of mortality cases and severe morbidity case compared to other previous reports. The authors would like to emphasize the importance of acute postoperative care in young pediatric patients as well as meticulous surgical techniques to reduce morbidity and mortality in epilepsy surgery.
Epilepsy surgery: past, present and future
Seizure-european Journal of Epilepsy, 1998
Although epilepsy surgery has met with increased interest in recent years it is still underused in most countries, particularly third-world countries. Possible reasons for the recent expansion in epilepsy surgery in the so-called developed countries include the availability of advanced non-invasive diagnostic tools to delineate epileptogenic lesions and epilepsy-related functional deficits. and to prove 'epileptogenicity'. Improved surgical techniques are, however, equally important. This translates into better postsurgical outcome figures and into a larger population of difficult-to-treat patients profiting from surgical therapy. There is, also. an important role for epilepsy surgery within the modem neuroscience field. A critical review and analysis of the present state-of-the-art epilepsy surgery is presented and possible scenarios for its future development are outlined. Within this framework the conceptual differentiation of epilepsy surgery into three categories-'lesion-oriented surgery', 'epilepsy-oriented lesional surgery' and 'epilepsy surgery SEXISTS srr-icro'-is maintained, since it is relevant to the organization of epilepsy centres. The growing need for quality control and multidiiciplinary and worldwide collaboration is emphasized.
Effectiveness and safety of epilepsy surgery: what is the evidence?
CNS spectrums, 2004
Evidence from a recent randomized controlled trial of surgical versus medical therapy of temporal lobe epilepsy proves that antero-mesial resection is safe and more effective than medical therapy. The number of patients needed to treat for one patient to become free of disabling seizures is two, which is superior to most interventions in neurology. A meta-analysis of non-randomized trials gives almost identical results; about two-thirds of patients become seizure-free, compared with only 8% with medical therapy. The results are remarkably similar among studies from different parts of the world. Quality of life improves early after epilepsy surgery, the improvements are both statistically and clinically significant, and they are sustained. Surgical morbidity with clinically important permanent sequelae is 2%. Epilepsy surgery remains underutilized in developed countries and it does not exist in all but a few developing countries. Current randomized trials are underway to explore the ...