Good news from epilepsy surgery treatment in Sweden

This is my 9th blog on epilepsy. In this blog you find new Good news from epilepsy surgery treatment in Sweden

 

Epilepsy

This is a neurological condition, which affects the nervous system. Epilepsy is also known as a seizure disorder. It is usually diagnosed after a person has had at least two seizures that were not caused by some known medical condition like alcohol withdrawal, extremely low blood sugar, heart problems or some other medical condition. Sometimes, according to the International League against Epilepsy, epilepsy can be diagnosed after one seizure, if a person has a condition that places them at high risk for having another.

Seizures

Seizures are a symptom of something going on in the brain. Seizures seen in epilepsy are caused by disturbances in the electrical activity of the brain. The seizures in epilepsy may be related to a brain injury or a family tendency, but most of the time the cause is unknown. The word "epilepsy" does not indicate anything about the cause of the person's seizures, what type they are, or how severe they are. There are many different types of seizures.

Type brain surgery for epilepsy

The kind of seizures you have and the part of your brain where they begin will determine whether surgery is likely to help you. The same things also will determine the specific type of operation that you should have.

There are two main types of brain surgery for epilepsy.

 

1 Resective surgery

The first, and by far the most common, is called resection or resective surgery. In this type, the surgeon removes the area of the brain that causes the patient's seizures. (The name of the specific procedure generally ends with "ectomy," which means removal by cutting.) The most common example of this type of surgery is the temporal lobectomy, in which part of the temporal lobe of the brain is removed. The goal of resective surgery for epilepsy is most often cure of the seizure disorder.

2.Disconnection procedures

The second, less common type of epilepsy surgery interrupts nerve pathways that allow seizures to spread. The term disconnection is sometimes used to describe it. One example of this kind of procedure is called a corpus callosotomy. (When you see "otomy" at the end of a word, it means that that thing is being cut.) A procedure called multiple subpial transections is another example of this type of surgery. This procedure may be helpful when seizures begin in areas that are too important to remove. Disconnection procedures are generally thought of as providing relief, but not a cure.

New Study-Long-term outcomes of epilepsy surgery in Sweden

Objective

To investigate prospective, population-based long-term outcomes concerning seizures and antiepileptic drug (AED) treatment after resective epilepsy surgery in Sweden.

Methods

Ten- and 5-year follow-ups were performed in 2005 to 2007 for 278/327 patients after resective epilepsy surgery from 1995 to 1997 and 2000 to 2002, respectively. All patients had been prospectively followed in the Swedish National Epilepsy Surgery Register. Ninety-three patients, who were pre-surgically evaluated but not operated, served as controls.

Results

In the long term (mean 7.6 years), 62% of operated adults and 50% of operated children were seizure-free, compared to 14% of nonoperated adults (p < 0.001) and 38% of nonoperated children (not significant). Forty-one percent of operated adults and 44% of operated children had sustained seizure freedom since surgery, compared to none of the controls (p < 0.0005). Multivariate analysis identified ≥30 seizures/month at baseline and long epilepsy duration as negative predictors and positive MRI to be a positive predictor of long-term seizure-free outcome. Ten years after surgery, 86% of seizure-free children and 43% of seizure-free adults had stopped AEDs in the surgery groups compared to none of the controls (p < 0.0005).

Conclusions

This population-based, prospective study shows good long-term seizure outcomes after respective epilepsy surgery. The majority of the patients who are seizure-free after 5 and 10 years have sustained seizure freedom since surgery. Many patients who gain seizure freedom can successfully discontinue AEDs, more often children than adults.

Classification of evidence

This study provides Class III evidence that more patients are seizure-free and have stopped AED treatment in the long term after respective epilepsy surgery than non-operated epilepsy patients.

(Source- American Academy of Neurology)