Background: Surgery is a widely accepted treatment option for drug-resistant focal epilepsy. A detailed analysis of longitudinal postoperative seizure outcomes and use of antiepileptic drugs for different brain lesions causing epilepsy is not available. We aimed to analyse the association between histopathology and seizure outcome and drug freedom up to 5 years after epilepsy surgery, to improve presurgical decision making and counselling. Methods: In this retrospective, multicentre, longitudinal, cohort study, patients who had epilepsy surgery between Jan 1, 2000, and Dec 31, 2012, at 37 collaborating tertiary referral centres across 18 European countries of the European Epilepsy Brain Bank consortium were assessed. We included patients of all ages with histopathology available after epilepsy surgery. Histopathological diagnoses and a minimal dataset of clinical variables were collected from existing local databases and patient records. The primary outcomes were freedom from disabling seizures (Engel class 1) and drug freedom at 1, 2, and 5 years after surgery. Proportions of individuals who were Engel class 1 and drug-free were reported for the 11 main categories of histopathological diagnosis. We analysed the association between histopathology, duration of epilepsy, and age at surgery, and the primary outcomes using random effects multivariable logistic regression to control for confounding. Findings: 9147 patients were included, of whom seizure outcomes were available for 8191 (89·5%) participants at 2 years, and for 5577 (61·0%) at 5 years. The diagnoses of low-grade epilepsy associated neuroepithelial tumour (LEAT), vascular malformation, and hippocampal sclerosis had the best seizure outcome at 2 years after surgery, with 77·5% (1027 of 1325) of patients free from disabling seizures for LEAT, 74·0% (328 of 443) for vascular malformation, and 71·5% (2108 of 2948) for hippocampal sclerosis. The worst seizure outcomes at 2 years were seen for patients with focal cortical dysplasia type I or mild malformation of cortical development (50·0%, 213 of 426 free from disabling seizures), those with malformation of cortical development-other (52·3%, 212 of 405 free from disabling seizures), and for those with no histopathological lesion (53·5%, 396 of 740 free from disabling seizures). The proportion of patients being both Engel class 1 and drug-free was 0-14% at 1 year and increased to 14-51% at 5 years. Children were more often drug-free; temporal lobe surgeries had the best seizure outcomes; and a longer duration of epilepsy was associated with reduced chance of favourable seizure outcomes and drug freedom. This effect of duration was evident for all lesions, except for hippocampal sclerosis. Interpretation: Histopathological diagnosis, age at surgery, and duration of epilepsy are important prognostic factors for outcomes of epilepsy surgery. In every patient with refractory focal epilepsy presumed to be lesional, evaluation for surgery should be considered.
Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study / Herm J Lamberink 1 , Willem M Otte 1 , Ingmar Blümcke 2 , Kees P J Braun 1 , European Epilepsy Brain Bank writing group; Martin Aichholzer, Isabel Amorim, Javier Aparicio, Eleonora Aronica, Alexis Arzimanoglou, Carmen Barba, Jürgen Beck, Albert Becker, Jan C Beckervordersandforth, Christian G Bien, Ingmar Blümcke, Istvan Bodi, Kees Pj Braun, Helene Catenoix, Francine Chassoux, Mathilde Chipaux, Thomas Cloppenborg, Roland Coras, J Helen Cross, Luca De Palma, Jane De Tisi, Francesco Deleo, Bertrand Devaux, Giancarlo Di Gennaro, Georg Dorfmüller, John S Duncan, Christian Elger, Katharina Ernst, Vincenzo Esposito, Martha Feucht, Zeljka Petelin Gadze, Rita Garbelli, Karin Geleijns, Antonio Gil-Nagel, Alexander Grote, Thomas Grunwald, Renzo Guerrini, Hajo Hamer, Mrinalini Honavar, Thomas S Jacques, Antonia Jakovcevic, Leena Jutila, Adam Kalina, Reetta Kälviäinen, Karl Martin Klein, Kristina Koenig, Pavel Krsek, Manfred Kudernatsch, Martin Kudr, Herm J Lamberink, Kristina Malmgren, Petr Marusic, Armen Melikyan, Katja Menzler, Soheyl Noachtar, Willem M Otte, Çiğdem Özkara, Tom Pieper, Jose Pimentel, Savo Raicevic, Sylvain Rheims, Joana Ribeiro, Felix Rosenow, Karl Rössler, Bertil Rydenhag, Francisco Sales, Victoria San Antonio-Arce, Karl Lothar Schaller, Olaf Schijns, Theresa Scholl, Johannes Schramm, Andreas Schulze-Bonhage, Raf Sciot, Margitta Seeck, Lyudmila Shishkina, Dragoslav Sokic, Nicola Specchio, Tom Theys, Maria Thom, Rafael Toledano Delgado, Joseph Toulouse, Mustafa Uzan, Johannes van Loon, Wim Van Paesschen, Tim J von Oertzen, Floor Jansen, Frans Leijten, Peter van Rijen, Wim Gm Spliet, Angelika Mühlebner, Burkhard S Kasper, Susanne Fauser, Tilman Polster, Thilo Kalbhenn, Daniel Delev, Andrew McEvoy, Anna Miserocchi, Elisabeth Landré, Bares Turak, Pascale Varlet, Sarah Ferrand-Sorbets, Martine Fohlen, Christine Bulteau, Anna Edelvik, Mukesch J Shah, Christian Scheiwe, Eva Gutierrez Delicado, Martin Tisdall, Christin Eltze, Serdar Akkol, Kaancan Deniz, Buge Oz, Hans Holthausen, Till Hartlieb, Martin Staudt, Sara Casciato, Pier P Quarato, Felice Giangaspero, Nathalie Streichenberger, Marc Guenot, Jean Isnard, Antonio Valentijn, Amanda Chang, Nandini Mullatti, Josef Zamecnik, Jana Zarubova, Martin Tomasek, Arto Immonen, Anni Saarela, Tuomas Rauramaa, Johannes A Lobrinus, Kristof Egervari, Shahan Momjian, Elisabeth Harti, Hannah Lohr, Judith Kroell, Lynn Vermeulen, Evy Cleeren, Pavel Vlasov, Antonia Kozlova, Alexey Vorobyev, Gudrun Goeppel, Sharon Samueli, Thomas Czech, Johannes Hainfellner, Gertraud Puttinger, Gabriele Schwarz, Harald Stefanits, Serge Weis, Roberto Spreafico, Flavio Villani, Laura Rossini, Anke Hermsen, Susanne Knake, Christopher Nimsky, Barbara Carl, Anezka Belohlavkova, Barbora Benova, Jeroen Bisschop, Albert Colon, Vivianne van Kranen-Mastenbroek, Rob Pw Rouhl, Govert Hoogland, Jordi Rumiá, Alia Ramírez-Camacho, Santiago Candela-Cantó, Karine Ostrowsky-Coste, Eleni Panagiotakaki, Alexandra Montavont, Pascale Keo Kosal, Zeynep Gokce-Samar, Clara Milleret, Anna M Buccoliero, Flavio Giordano, Vlatko Sulentic, Goran Mrak, Andrej Desnica, Giusy CarfíPavia, Alessandro De Benedictis, Carlo E Marras, Vladimir Bascarevic, Nikola Vojvodic, Aleksandar Ristic, Olinda Rebelo, Angel Aledo-Serrano, Irene Garcia-Morales, Carla Anciones; study group; European Reference Network EpiCARE. - In: LANCET NEUROLOGY. - ISSN 1474-4422. - ELETTRONICO. - 19:(2020), pp. 748-757. [10.1016/S1474-4422(20)30220-9]
Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study
Carmen BarbaWriting – Review & Editing
;Renzo GuerriniWriting – Review & Editing
;Flavio GiordanoMembro del Collaboration Group
;
2020
Abstract
Background: Surgery is a widely accepted treatment option for drug-resistant focal epilepsy. A detailed analysis of longitudinal postoperative seizure outcomes and use of antiepileptic drugs for different brain lesions causing epilepsy is not available. We aimed to analyse the association between histopathology and seizure outcome and drug freedom up to 5 years after epilepsy surgery, to improve presurgical decision making and counselling. Methods: In this retrospective, multicentre, longitudinal, cohort study, patients who had epilepsy surgery between Jan 1, 2000, and Dec 31, 2012, at 37 collaborating tertiary referral centres across 18 European countries of the European Epilepsy Brain Bank consortium were assessed. We included patients of all ages with histopathology available after epilepsy surgery. Histopathological diagnoses and a minimal dataset of clinical variables were collected from existing local databases and patient records. The primary outcomes were freedom from disabling seizures (Engel class 1) and drug freedom at 1, 2, and 5 years after surgery. Proportions of individuals who were Engel class 1 and drug-free were reported for the 11 main categories of histopathological diagnosis. We analysed the association between histopathology, duration of epilepsy, and age at surgery, and the primary outcomes using random effects multivariable logistic regression to control for confounding. Findings: 9147 patients were included, of whom seizure outcomes were available for 8191 (89·5%) participants at 2 years, and for 5577 (61·0%) at 5 years. The diagnoses of low-grade epilepsy associated neuroepithelial tumour (LEAT), vascular malformation, and hippocampal sclerosis had the best seizure outcome at 2 years after surgery, with 77·5% (1027 of 1325) of patients free from disabling seizures for LEAT, 74·0% (328 of 443) for vascular malformation, and 71·5% (2108 of 2948) for hippocampal sclerosis. The worst seizure outcomes at 2 years were seen for patients with focal cortical dysplasia type I or mild malformation of cortical development (50·0%, 213 of 426 free from disabling seizures), those with malformation of cortical development-other (52·3%, 212 of 405 free from disabling seizures), and for those with no histopathological lesion (53·5%, 396 of 740 free from disabling seizures). The proportion of patients being both Engel class 1 and drug-free was 0-14% at 1 year and increased to 14-51% at 5 years. Children were more often drug-free; temporal lobe surgeries had the best seizure outcomes; and a longer duration of epilepsy was associated with reduced chance of favourable seizure outcomes and drug freedom. This effect of duration was evident for all lesions, except for hippocampal sclerosis. Interpretation: Histopathological diagnosis, age at surgery, and duration of epilepsy are important prognostic factors for outcomes of epilepsy surgery. In every patient with refractory focal epilepsy presumed to be lesional, evaluation for surgery should be considered.
I documenti in FLORE sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
