Seizure outcomes in people with drug-resistant focal epilepsy evaluated for surgery but do not proceed

Khoo, Anthony; de Tisi, Jane; Mannan, Shahidul; O’Keeffe, Aidan G.; Sander, Josemir W.; Duncan, John S.

Abstract

Objective: To ascertain seizure outcomes in people with drug-resistant focal epilepsy considered for epilepsy surgery but who did not proceed. Methods: We identified people discussed at a weekly presurgical epilepsy multi-disciplinary (MDT) meeting from January 2015 to December 2019 and in whom a decision not to proceed to surgery was made. Seizure outcomes were obtained from individuals, primary care physicians and attending neurologists at a minimum of 12 months following the not to proceed decision. Results: We considered 315 people who did not proceed to surgery after evaluation. Nine died, and 25 were lost to follow-up. We included 281 people with a median follow-up of 2.4 (IQR 1.5–4) years. In total, 83 (30%) people reported that seizures had improved or resolved since the MDT meeting. Thirteen (5%) were seizure-free over the last 12 months of follow-up, 70 (25%) had experienced more than 50% reduction in seizure frequency, 180 (64%) had no meaningful change, and 18 (6%) reported a doubling of seizure frequency. Of the 53 (16%) who had vagal nerve stimulation, 19/53 (37%) reported more than 50% reduction in frequency, including one seizure-free. Significance: The chances of seizure freedom with further medications and neurostimulation are low for people with drug-resistant focal epilepsy who have been evaluated for surgery and do not proceed, but improvement may still occur. Up to a quarter have a > 50% reduction in seizures, and one in twenty become seizure-free eventually. Trying additional anti-seizure medication and neurostimulation is worthwhile in this population.

Citation

Khoo, A., de Tisi, J., Mannan, S., O’Keeffe, A. G., Sander, J. W., & Duncan, J. S. (2021). Seizure outcomes in people with drug-resistant focal epilepsy evaluated for surgery but do not proceed. Epilepsy Research, 178, Article 106822. https://doi.org/10.1016/j.eplepsyres.2021.106822

• Journal Article Type: Article
• Acceptance Date: Nov 16, 2021
• Online Publication Date: Nov 23, 2021
• Publication Date: Dec 1, 2021
• Deposit Date: Dec 15, 2021
• Publicly Available Date: Nov 24, 2022
• Journal: Epilepsy Research
• Print ISSN: 0920-1211
• Electronic ISSN: 1872-6844
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 178
• Article Number: 106822
• DOI: https://doi.org/10.1016/j.eplepsyres.2021.106822
• Keywords: Clinical Neurology; Neurology
• Public URL: https://nottingham-repository.worktribe.com/output/7017980
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0920121121002771?via%3Dihub