Document Detail


Long-term outcome of nonsurgical candidates with medically refractory localization-related epilepsy.
MedLine Citation:
PMID:  14636329     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Epilepsy surgery can result in complete seizure remission rates of upto 80% in patients with mesial temporal sclerosis and unilateral seizures. The seizure-free rate after surgery for patients with extratemporal nonlesional epilepsy has ranged between 30% and 40%. Some patients with medically refractory localization-related epilepsy cannot be offered surgical resection because of inadequate localization of the epileptogenic zone, documentation of bilateral ictal onsets, or functionally important areas of cortex that prohibit resection. The short-term rate of complete remission with medications in temporal lobe epilepsy is poor. Less is known about remission rates in patients who are not surgical candidates. In this study, we evaluated the outcome of medical treatment in patients with medically refractory partial epilepsy who were evaluated for possible epilepsy surgery but deemed to be inadequate surgical candidates. METHODS: A retrospective chart review and telephone survey with a self-rating questionnaire were completed for all patients who underwent epilepsy surgery evaluation but were not ultimately offered surgical treatment at the University of Michigan from 1990 through 1998. We assessed changes in seizure frequency and type, imaging characteristics, ictal recordings, interim medication history, and subjective changes in quality of life. RESULTS: Thirty-four subjects were available for follow-up study, at an average of >4 years after surgical evaluation. A significant reduction in seizure frequency was noted at the time of follow-up compared with that at the time of surgical evaluation. Of patients, 21% achieved seizure remission and remained seizure free for an average of 2.5 years. Four of the seven seizure-free patients attributed their remission to new antiepileptic drugs (AEDs). On a global self-rating item, 15 of 34, or 44%, felt more or much more satisfied with their lives, and 41% felt their quality of life was stable. CONCLUSIONS: A surprisingly large number of patients we surveyed, with refractory partial epilepsy not eligible for surgical management, reported reduced seizure frequency at follow-up, and 21% were seizure free. Our findings suggest that the long-term prognosis in patients with refractory partial epilepsy who are not surgical candidates may be more positive than might be generally expected.
Authors:
Linda M Selwa; Shelley L Schmidt; Beth A Malow; Ahmad Beydoun
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Epilepsia     Volume:  44     ISSN:  0013-9580     ISO Abbreviation:  Epilepsia     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-11-25     Completed Date:  2004-02-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1568-72     Citation Subset:  IM    
Affiliation:
Department of Neurology, University of Michigan Medical School, 1500 East Medical Center Drive, 1914/0316 Taubman, Ann Arbor, MI 48109-0316, USA. lmselwa@umich.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Anticonvulsants / adverse effects,  therapeutic use*
Drug Resistance, Multiple
Drug Therapy, Combination
Electric Stimulation Therapy / instrumentation
Electrodes, Implanted
Epilepsies, Partial / diagnosis,  psychology,  surgery*
Epilepsy, Temporal Lobe / diagnosis,  psychology,  surgery*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Patient Satisfaction
Psychosurgery*
Quality of Life / psychology
Retrospective Studies
Sclerosis
Temporal Lobe / pathology,  surgery
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticonvulsants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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