Does epilepsy surgery lower the mortality of drug-resistant epilepsy?

Details

Serval ID
serval:BIB_E99250B6C102
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Title
Does epilepsy surgery lower the mortality of drug-resistant epilepsy?
Journal
Epilepsy Res
Author(s)
Ryvlin P., Kahane P.
ISSN
0920-1211 (Print)
ISSN-L
0920-1211
Publication state
Published
Issued date
10/2003
Volume
56
Number
2-3
Pages
105-20
Language
english
Notes
Ryvlin, P
Kahane, P
eng
Review
Netherlands
Epilepsy Res. 2003 Oct;56(2-3):105-20.
Abstract
Drug-resistant epilepsy has proved to be associated with an increased standardized mortality ratio (SMR), primarily due to seizure-related fatalities including sudden unexpected death (SUDEP). Recent studies have suggested that the surgical cure of temporal lobe epilepsy (TLE) was likely to normalize the SMR of patients suffering from refractory TLE. However, these studies raise a number of methodological issues, which have not always been fully addressed. Some conclusions have relied on previously reported data, indicating a SMR of approximately 5, and a SUDEP incidence of 9/1000 patient-years in drug-resistant epilepsy. In fact, as shown in this review, SMR varied considerably, from 2 to 16, in the various series of patients with refractory epilepsy, whereas the average SUDEP incidence in the same populations was calculated at 3.7/1000 patient-years. Other conclusions were based on the comparison of either surgically and medically treated patients, or cured and non-cured operated patients. In both situations, the two groups included a different proportion of excellent and poor surgical candidates. The biological differences that distinguish these two populations might explain part of the differences observed in their mortality rate, regardless of the effect of surgery. In particular, temporal-plus epilepsies involving the insula, the frontal orbital, or the frontal operculum region, might favour ictal arrhythmias, central apnoea and secondary generalization, which in turn would increase the risk of SUDEP. Future studies are thus warranted to specifically address these issues.
Keywords
Age Factors, Animals, Drug Resistance, Epilepsy/*mortality/physiopathology/*surgery, Epilepsy, Temporal Lobe/mortality/surgery, Humans, Risk Factors, Seizures/mortality, Treatment Outcome
Pubmed
Create date
29/11/2018 12:37
Last modification date
20/08/2019 16:12
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