Surgical outcome and prognostic factors of frontal lobe epilepsy surgery
Frontal lobe epilepsy (FLE) surgery is the second most common surgery performed to treat pharmacoresistant epilepsy. Yet, little is known about long-term seizure outcome following frontal lobectomy. The aim of this study is to investigate the trends in longitudinal outcome and identify potential pro...
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description | Frontal lobe epilepsy (FLE) surgery is the second most common surgery performed to treat pharmacoresistant epilepsy. Yet, little is known about long-term seizure outcome following frontal lobectomy. The aim of this study is to investigate the trends in longitudinal outcome and identify potential prognostic indicators in a cohort of FLE patients investigated using modern diagnostic techniques. We reviewed 70 patients who underwent a frontal lobectomy between 1995 and 2003 (mean follow-up 4.1 ± 3 years). Data were analysed using survival analysis and multivariate regression with Cox proportional hazard models. A favourable outcome was defined as complete seizure-freedom, allowing for auras and seizures restricted to the first post-operative week. The estimated probability of complete seizure-freedom was 55.7% [95% confidence interval (CI) = 50–62] at 1 post-operative year, 45.1% (95% CI = 39–51) at 3 years, and 30.1% (95% CI = 21–39) at 5 years. Eighty per cent of seizure recurrences occurred within the first 6 post-operative months. Late remissions and relapses occurred, but were rare. After multivariate analysis, the following variables retained their significance as independent predictors of seizure recurrence: MRI-negative malformation of cortical development as disease aetiology [risk ratio (RR) = 2.22, 95% CI = 1.40–3.47], any extrafrontal MRI abnormality (RR = 1.75, 95% CI = 1.12–2.69), generalized/non-localized ictal EEG patterns (RR = 1.83, 95% CI = 1.15–2.87), occurrence of acute post-operative seizures (RR = 2.17, 95% CI = 1.50–3.14) and incomplete surgical resection (RR = 2.56, 95% CI = 1.66–4.05) (log likelihood-ratio test P-value < 0.0001). More than half of patients in favourable prognostic categories were seizure-free at 3 years, and up to 40% were seizure-free at 5 years, compared to |
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Yet, little is known about long-term seizure outcome following frontal lobectomy. The aim of this study is to investigate the trends in longitudinal outcome and identify potential prognostic indicators in a cohort of FLE patients investigated using modern diagnostic techniques. We reviewed 70 patients who underwent a frontal lobectomy between 1995 and 2003 (mean follow-up 4.1 ± 3 years). Data were analysed using survival analysis and multivariate regression with Cox proportional hazard models. A favourable outcome was defined as complete seizure-freedom, allowing for auras and seizures restricted to the first post-operative week. The estimated probability of complete seizure-freedom was 55.7% [95% confidence interval (CI) = 50–62] at 1 post-operative year, 45.1% (95% CI = 39–51) at 3 years, and 30.1% (95% CI = 21–39) at 5 years. Eighty per cent of seizure recurrences occurred within the first 6 post-operative months. Late remissions and relapses occurred, but were rare. After multivariate analysis, the following variables retained their significance as independent predictors of seizure recurrence: MRI-negative malformation of cortical development as disease aetiology [risk ratio (RR) = 2.22, 95% CI = 1.40–3.47], any extrafrontal MRI abnormality (RR = 1.75, 95% CI = 1.12–2.69), generalized/non-localized ictal EEG patterns (RR = 1.83, 95% CI = 1.15–2.87), occurrence of acute post-operative seizures (RR = 2.17, 95% CI = 1.50–3.14) and incomplete surgical resection (RR = 2.56, 95% CI = 1.66–4.05) (log likelihood-ratio test P-value < 0.0001). More than half of patients in favourable prognostic categories were seizure-free at 3 years, and up to 40% were seizure-free at 5 years, compared to <15% in those with unfavourable outcome predictors. These data underscore the importance of appropriate selection of potential surgical candidates.</description><identifier>ISSN: 0006-8950</identifier><identifier>EISSN: 1460-2156</identifier><identifier>DOI: 10.1093/brain/awl364</identifier><identifier>PMID: 17209228</identifier><identifier>CODEN: BRAIAK</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adolescent ; Adult ; Biological and medical sciences ; Child ; Child, Preschool ; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases ; Electroencephalography ; Epidemiologic Methods ; Epilepsy ; Epilepsy, Frontal Lobe - diagnosis ; Epilepsy, Frontal Lobe - physiopathology ; Epilepsy, Frontal Lobe - surgery ; epileptology ; Female ; frontal lobe ; Frontal Lobe - surgery ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Middle Aged ; Nervous system (semeiology, syndromes) ; Neurology ; outcome ; Patient Selection ; Positron-Emission Tomography ; Prognosis ; Recurrence ; surgery ; Treatment Outcome</subject><ispartof>Brain (London, England : 1878), 2007-02, Vol.130 (2), p.574-584</ispartof><rights>The Author (2007). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org 2007</rights><rights>2007 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Feb 2007</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c551t-a44490d918fe748dc8ef659c0172ff2e0ad3a40ee036572e2371b276fe75dfd93</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18487712$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17209228$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jeha, Lara E.</creatorcontrib><creatorcontrib>Najm, Imad</creatorcontrib><creatorcontrib>Bingaman, William</creatorcontrib><creatorcontrib>Dinner, Dudley</creatorcontrib><creatorcontrib>Widdess-Walsh, Peter</creatorcontrib><creatorcontrib>Lüders, Hans</creatorcontrib><title>Surgical outcome and prognostic factors of frontal lobe epilepsy surgery</title><title>Brain (London, England : 1878)</title><addtitle>Brain</addtitle><description>Frontal lobe epilepsy (FLE) surgery is the second most common surgery performed to treat pharmacoresistant epilepsy. Yet, little is known about long-term seizure outcome following frontal lobectomy. The aim of this study is to investigate the trends in longitudinal outcome and identify potential prognostic indicators in a cohort of FLE patients investigated using modern diagnostic techniques. We reviewed 70 patients who underwent a frontal lobectomy between 1995 and 2003 (mean follow-up 4.1 ± 3 years). Data were analysed using survival analysis and multivariate regression with Cox proportional hazard models. A favourable outcome was defined as complete seizure-freedom, allowing for auras and seizures restricted to the first post-operative week. The estimated probability of complete seizure-freedom was 55.7% [95% confidence interval (CI) = 50–62] at 1 post-operative year, 45.1% (95% CI = 39–51) at 3 years, and 30.1% (95% CI = 21–39) at 5 years. Eighty per cent of seizure recurrences occurred within the first 6 post-operative months. Late remissions and relapses occurred, but were rare. After multivariate analysis, the following variables retained their significance as independent predictors of seizure recurrence: MRI-negative malformation of cortical development as disease aetiology [risk ratio (RR) = 2.22, 95% CI = 1.40–3.47], any extrafrontal MRI abnormality (RR = 1.75, 95% CI = 1.12–2.69), generalized/non-localized ictal EEG patterns (RR = 1.83, 95% CI = 1.15–2.87), occurrence of acute post-operative seizures (RR = 2.17, 95% CI = 1.50–3.14) and incomplete surgical resection (RR = 2.56, 95% CI = 1.66–4.05) (log likelihood-ratio test P-value < 0.0001). More than half of patients in favourable prognostic categories were seizure-free at 3 years, and up to 40% were seizure-free at 5 years, compared to <15% in those with unfavourable outcome predictors. These data underscore the importance of appropriate selection of potential surgical candidates.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</subject><subject>Electroencephalography</subject><subject>Epidemiologic Methods</subject><subject>Epilepsy</subject><subject>Epilepsy, Frontal Lobe - diagnosis</subject><subject>Epilepsy, Frontal Lobe - physiopathology</subject><subject>Epilepsy, Frontal Lobe - surgery</subject><subject>epileptology</subject><subject>Female</subject><subject>frontal lobe</subject><subject>Frontal Lobe - surgery</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Humans</subject><subject>Infant</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>outcome</subject><subject>Patient Selection</subject><subject>Positron-Emission Tomography</subject><subject>Prognosis</subject><subject>Recurrence</subject><subject>surgery</subject><subject>Treatment Outcome</subject><issn>0006-8950</issn><issn>1460-2156</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0ctv1DAQBnALgei2cOOMIiTgQuj4ET-OqKIs0goOPMXF8jrjKiUbp3Yi2P8eL1lRiUtPvvz0zXg-Qp5QeE3B8PNtct1w7n71XIp7ZEWFhJrRRt4nKwCQtTYNnJDTnK8BqOBMPiQnVDEwjOkVWX-a01XnXV_FefJxh5Ub2mpM8WqIeep8FZyfYspVDFVIcZiK7OMWKxy7Hse8r3IJwLR_RB4E12d8fHzPyJfLt58v1vXm47v3F282tW8aOtVOCGGgNVQHVEK3XmOQjfFQVgqBIbiWOwGIwGWjGDKu6JYpWXTThtbwM_JiyS073syYJ7vrsse-dwPGOVupDQej4U5ITcMlqEPis__gdZzTUD5xMIIbI1VBrxbkU8w5YbBj6nYu7S0Fe-jB_u3BLj0U_vSYOW932N7i4-ELeH4ELpfrh-QG3-Vbp4VWirLiXi4uzuNdI-tFdnnC3_-sSz9t2V81dv39h5XfNl8_aG0s8D_LJa4P</recordid><startdate>20070201</startdate><enddate>20070201</enddate><creator>Jeha, Lara E.</creator><creator>Najm, Imad</creator><creator>Bingaman, William</creator><creator>Dinner, Dudley</creator><creator>Widdess-Walsh, Peter</creator><creator>Lüders, Hans</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7QR</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20070201</creationdate><title>Surgical outcome and prognostic factors of frontal lobe epilepsy surgery</title><author>Jeha, Lara E. ; Najm, Imad ; Bingaman, William ; Dinner, Dudley ; Widdess-Walsh, Peter ; Lüders, Hans</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c551t-a44490d918fe748dc8ef659c0172ff2e0ad3a40ee036572e2371b276fe75dfd93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</topic><topic>Electroencephalography</topic><topic>Epidemiologic Methods</topic><topic>Epilepsy</topic><topic>Epilepsy, Frontal Lobe - diagnosis</topic><topic>Epilepsy, Frontal Lobe - physiopathology</topic><topic>Epilepsy, Frontal Lobe - surgery</topic><topic>epileptology</topic><topic>Female</topic><topic>frontal lobe</topic><topic>Frontal Lobe - surgery</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Humans</topic><topic>Infant</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>outcome</topic><topic>Patient Selection</topic><topic>Positron-Emission Tomography</topic><topic>Prognosis</topic><topic>Recurrence</topic><topic>surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jeha, Lara E.</creatorcontrib><creatorcontrib>Najm, Imad</creatorcontrib><creatorcontrib>Bingaman, William</creatorcontrib><creatorcontrib>Dinner, Dudley</creatorcontrib><creatorcontrib>Widdess-Walsh, Peter</creatorcontrib><creatorcontrib>Lüders, Hans</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Brain (London, England : 1878)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jeha, Lara E.</au><au>Najm, Imad</au><au>Bingaman, William</au><au>Dinner, Dudley</au><au>Widdess-Walsh, Peter</au><au>Lüders, Hans</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical outcome and prognostic factors of frontal lobe epilepsy surgery</atitle><jtitle>Brain (London, England : 1878)</jtitle><addtitle>Brain</addtitle><date>2007-02-01</date><risdate>2007</risdate><volume>130</volume><issue>2</issue><spage>574</spage><epage>584</epage><pages>574-584</pages><issn>0006-8950</issn><eissn>1460-2156</eissn><coden>BRAIAK</coden><abstract>Frontal lobe epilepsy (FLE) surgery is the second most common surgery performed to treat pharmacoresistant epilepsy. Yet, little is known about long-term seizure outcome following frontal lobectomy. The aim of this study is to investigate the trends in longitudinal outcome and identify potential prognostic indicators in a cohort of FLE patients investigated using modern diagnostic techniques. We reviewed 70 patients who underwent a frontal lobectomy between 1995 and 2003 (mean follow-up 4.1 ± 3 years). Data were analysed using survival analysis and multivariate regression with Cox proportional hazard models. A favourable outcome was defined as complete seizure-freedom, allowing for auras and seizures restricted to the first post-operative week. The estimated probability of complete seizure-freedom was 55.7% [95% confidence interval (CI) = 50–62] at 1 post-operative year, 45.1% (95% CI = 39–51) at 3 years, and 30.1% (95% CI = 21–39) at 5 years. Eighty per cent of seizure recurrences occurred within the first 6 post-operative months. Late remissions and relapses occurred, but were rare. After multivariate analysis, the following variables retained their significance as independent predictors of seizure recurrence: MRI-negative malformation of cortical development as disease aetiology [risk ratio (RR) = 2.22, 95% CI = 1.40–3.47], any extrafrontal MRI abnormality (RR = 1.75, 95% CI = 1.12–2.69), generalized/non-localized ictal EEG patterns (RR = 1.83, 95% CI = 1.15–2.87), occurrence of acute post-operative seizures (RR = 2.17, 95% CI = 1.50–3.14) and incomplete surgical resection (RR = 2.56, 95% CI = 1.66–4.05) (log likelihood-ratio test P-value < 0.0001). More than half of patients in favourable prognostic categories were seizure-free at 3 years, and up to 40% were seizure-free at 5 years, compared to <15% in those with unfavourable outcome predictors. These data underscore the importance of appropriate selection of potential surgical candidates.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>17209228</pmid><doi>10.1093/brain/awl364</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Adult Biological and medical sciences Child Child, Preschool Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Electroencephalography Epidemiologic Methods Epilepsy Epilepsy, Frontal Lobe - diagnosis Epilepsy, Frontal Lobe - physiopathology Epilepsy, Frontal Lobe - surgery epileptology Female frontal lobe Frontal Lobe - surgery Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Infant Magnetic Resonance Imaging Male Medical sciences Middle Aged Nervous system (semeiology, syndromes) Neurology outcome Patient Selection Positron-Emission Tomography Prognosis Recurrence surgery Treatment Outcome |
title | Surgical outcome and prognostic factors of frontal lobe epilepsy surgery |
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