European trends in epilepsy surgery.

Details

Serval ID
serval:BIB_1563F7552C02
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
European trends in epilepsy surgery.
Journal
Neurology
Author(s)
Baud M.O., Perneger T., Rácz A., Pensel M.C., Elger C., Rydenhag B., Malmgren K., Cross J.H., McKenna G., Tisdall M., Lamberink H.J., Rheims S., Ryvlin P., Isnard J., Mauguière F., Arzimanoglou A., Akkol S., Deniz K., Ozkara C., Lossius M., Rektor I., Kälviäinen R., Vanhatalo L.M., Dimova P., Minkin K., Staack A.M., Steinhoff B.J., Kalina A., Krsek P., Marusic P., Jordan Z., Fabo D., Carrette E., Boon P., Rocka S., Mameniškienė R., Vulliemoz S., Pittau F., Braun KPJ, Seeck M.
ISSN
1526-632X (Electronic)
ISSN-L
0028-3878
Publication state
Published
Issued date
10/07/2018
Peer-reviewed
Oui
Volume
91
Number
2
Pages
e96-e106
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Resective surgery is effective in treating drug-resistant focal epilepsy, but it remains unclear whether improved diagnostics influence postsurgical outcomes. Here, we compared practice and outcomes over 2 periods 15 years apart.
Sixteen European centers retrospectively identified 2 cohorts of children and adults who underwent epilepsy surgery in the period of 1997 to 1998 (n = 562) or 2012 to 2013 (n = 736). Data collected included patient (sex, age) and disease (duration, localization and diagnosis) characteristics, type of surgery, histopathology, Engel postsurgical outcome, and complications, as well as imaging and electrophysiologic tests performed for each case. Postsurgical outcome predictors were included in a multivariate logistic regression to assess the strength of date of surgery as an independent predictor.
Over time, the number of operated cases per center increased from a median of 31 to 50 per 2-year period (p = 0.02). Mean disease duration at surgery decreased by 5.2 years (p < 0.001). Overall seizure freedom (Engel class 1) increased from 66.7% to 70.9% (adjusted p = 0.04), despite an increase in complex surgeries (extratemporal and/or MRI negative). Surgeries performed during the later period were 1.34 times (adjusted odds ratio; 95% confidence interval 1.02-1.77) more likely to yield a favorable outcome (Engel class I) than earlier surgeries, and improvement was more marked in extratemporal and MRI-negative temporal epilepsy. The rate of persistent neurologic complications remained stable (4.6%-5.3%, p = 0.7).
Improvements in European epilepsy surgery over time are modest but significant, including higher surgical volume, shorter disease duration, and improved postsurgical seizure outcomes. Early referral for evaluation is required to continue on this encouraging trend.
Keywords
Adolescent, Adult, Child, Child, Preschool, Drug Resistant Epilepsy/epidemiology, Drug Resistant Epilepsy/surgery, Electrophysiological Phenomena, Europe/epidemiology, Female, Humans, Infant, Male, Middle Aged, Neuroimaging, Neurosurgical Procedures/statistics & numerical data, Postoperative Complications/epidemiology, Retrospective Studies, Time Factors, Treatment Outcome, Young Adult
Pubmed
Web of science
Create date
24/07/2018 11:54
Last modification date
12/09/2019 5:10
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