Abstract
Purpose. To review the postoperative seizure outcomes of patients that underwent surgery for epilepsy at King Faisal Specialist Hospital & Research Centre (KFSHRC). Methods. A descriptive retrospective study for 502 patients operated on for medically intractable epilepsy between 1998 and 2012. The surgical outcome was measured using the ILAE criteria. Results. The epilepsy surgery outcome for temporal lobe epilepsy surgery (ILAE classes 1, 2, and 3) at 12, 36, and 60 months is 79.6%, 74.2%, and 67%, respectively. The favorable 12- and 36-month outcomes for frontal lobe epilepsy surgery are 62% and 52%, respectively. For both parietal and occipital epilepsy lobe surgeries the 12- and 36-month outcomes are 67%. For multilobar epilepsy surgery, the 12- and 36-month outcomes are 65% and 50%, respectively. The 12- and 36-month outcomes for functional hemispherectomy epilepsy surgery are 64.2% and 63%, respectively. According to histopathology diagnosis, mesiotemporal sclerosis (MTS) and benign CNS tumors had the best favorable outcome after surgery at 1 year (77.27% and 84.3%, resp.,) and 3 years (76% and 75%, resp.,). The least favorable seizure-free outcome after 3 years occurred in cases with dual pathology (66.6%). Thirty-four epilepsy patients with normal magnetic resonance imaging (MRI) brain scans were surgically treated. The first- and third-year epilepsy surgery outcome of 17 temporal lobe surgeries were (53%) and (47%) seizure-free, respectively. The first- and third-year epilepsy surgery outcomes of 15 extratemporal epilepsy surgeries were (47%) and (33%) seizure-free. Conclusion. The best outcomes are achieved with temporal epilepsy surgery, mesial temporal sclerosis, and benign CNS tumor. The worst outcomes are from multilobar surgery, dual pathology, and normal MRI.
Highlights
The incidence of epilepsy in developed countries is currently estimated to be 57 people per 100,000 inhabitants [1], and the prevalence of active epilepsy is between 3 and 8 people per 1,000 citizens [2,3,4]
The invasive EEG procedure was performed in patients with intractable epilepsy in whom the clinical analysis, scalp EEG, magnetic resonance imaging (MRI), PET scan, and neuropsychology failed to lateralize seizure origin confidently
Figure 1: first-year epilepsy surgery outcome according to procedure
Summary
The incidence of epilepsy in developed countries is currently estimated to be 57 people per 100,000 inhabitants [1], and the prevalence of active epilepsy is between 3 and 8 people per 1,000 citizens [2,3,4]. The rate for active epilepsy in Saudi Arabia is 6.54 per 1,000 [5]. In Saudi Arabia, epilepsy disorders are common, with a hospital frequency rate of 8 per. Men were more frequently affected than women, and 60% of the patients were under 10 years of age at the onset of the illness [6]. Seventy to 80% of epilepsy patients can be satisfactorily managed with anticonvulsive medication [7] while 20% to 30% develop medically intractable epilepsy [8]. Epilepsy surgery started in the 19th century, but significant contributions were made to the procedure in the 20th century
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