Long-term seizure, psychiatric and socioeconomic outcomes after frontal lobe epilepsy surgery

Khoo, Anthony; de Tisi, Jane; Foong, Jacqueline; Bindman, Dorothea; O'Keeffe, Aidan G.; Sander, Josemir W.; Miserocchi, Anna; McEvoy, Andrew W.; Duncan, John S.

Abstract

Objective: Resective surgery for selected individuals with frontal lobe epilepsy can be effective, although multimodal outcomes are less established than in temporal lobe epilepsy. We describe long-term seizure remission and relapse patterns, psychiatric comorbidity, and socioeconomic outcomes following frontal lobe epilepsy surgery. Methods: We reviewed individual data on frontal lobe epilepsy procedures at our center between 1990 and 2020. This included the presurgical evaluation, operative details and annual postoperative seizure and psychiatric outcomes, prospectively recorded in an epilepsy surgery database. Outcome predictors were subjected to multivariable analysis, and rates of seizure freedom were analyzed using Kaplan-Meier methods. We used longitudinal assessment of the Index of Multiple Deprivation to assess change in socioeconomic status over time. Results: A total of 122 individuals with a median follow-up of seven years were included. Of these, 33 (27 %) had complete seizure freedom following surgery, with a further 13 (11 %) having only auras. Focal MRI abnormality, histopathology (focal cortical dysplasia, cavernoma or dysembryoplastic neuronal epithelial tumor) and fewer anti-seizure medications at the time of surgery were predictive of a favorable outcome; 67 % of those seizure-free for the first 12 months after surgery never experienced a seizure relapse. Thirty-one of 50 who had preoperative psychiatric pathology noticed improved psychiatric symptomatology by two years postoperatively. New psychiatric comorbidity was diagnosed in 15 (13 %). Persistent motor complications occurred in 5 % and dysphasia in 2 %. No significant change in socioeconomic deciles of deprivation was observed after surgery. Significance: Favorable long-term seizure, psychiatric and socioeconomic outcomes can be seen following frontal lobe epilepsy surgery. This is a safe and effective treatment that should be offered to suitable individuals early.

Citation

Khoo, A., de Tisi, J., Foong, J., Bindman, D., O'Keeffe, A. G., Sander, J. W., …Duncan, J. S. (2022). Long-term seizure, psychiatric and socioeconomic outcomes after frontal lobe epilepsy surgery. Epilepsy Research, 186, Article 106998. https://doi.org/10.1016/j.eplepsyres.2022.106998

• Journal Article Type: Article
• Acceptance Date: Aug 9, 2022
• Online Publication Date: Aug 13, 2022
• Publication Date: Oct 1, 2022
• Deposit Date: Aug 17, 2022
• Publicly Available Date: Aug 14, 2023
• Journal: Epilepsy Research
• Print ISSN: 0920-1211
• Electronic ISSN: 1872-6844
• Publisher: Elsevier BV
• Peer Reviewed: Peer Reviewed
• Volume: 186
• Article Number: 106998
• DOI: https://doi.org/10.1016/j.eplepsyres.2022.106998
• Keywords: Neurology (clinical); Neurology
• Public URL: https://nottingham-repository.worktribe.com/output/10079277
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0920121122001498
• Additional Information: This article is maintained by: Elsevier; Article Title: Long-term seizure, psychiatric and socioeconomic outcomes after frontal lobe epilepsy surgery; Journal Title: Epilepsy Research; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.eplepsyres.2022.106998