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Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study

2020; Elsevier BV; Volume: 19; Issue: 9 Linguagem: Inglês

10.1016/s1474-4422(20)30220-9

1474-4465

Herm J. Lamberink, Willem M. Otte, Ingmar Blümcke, Kees P. J. Braun, Martin Aichholzer, Isabel Amorim, Javier Aparicio, Eleonora Aronica, Alexis Arzimanoglou, Carmen Barba, Jürgen Beck, Albert J. Becker, Jan Beckervordersandforth, Christian G. Bien, Ingmar Blümcke, István Bódi, Kees P. J. Braun, Hélène Catenoix, Francine Chassoux, Mathilde Chipaux, Thomas Cloppenborg, Roland Coras, J. Helen Cross, Luca De Palma, Jane de Tisi, Francesco Deleo, Bertrand Devaux, Giancarlo Di Gennaro, Georg Dorfmüller, John S. Duncan, Christian E. Elger, Katharina Ernst, Vincenzo Esposito, Martha Feucht, Željka Petelin Gadže, Rita Garbelli, Karin Geleijns, António Gil‐Nagel, Alexander Grote, Thomas Grünwald, Renzo Guerrini, Hajo M. Hamer, Mrinalini Honavar, Thomas S. Jacques, Antonia Jakovčević, Leena Jutila, Adam Kalina, Reetta Kälviäinen, Karl Martin Klein, Kristina Koenig, Pavel Kršek, Manfred Kudernatsch, Martin Kudr, Herm J. Lamberink, Kristina Malmgren, Petr Marusič, A G Melikyan, Katja Menzler, Soheyl Noachtar, Willem M. Otte, Çiğdem Özkara, Tom Pieper, José Pimentel, Savo Raičević, Sylvain Rheims, Joana Ribeiro, Felix Rosenow, Karl Rössler, Bertil Rydenhag, Francisco Sales, Victoria San Antonio‐Arce, Karl Lothar Schaller, Olaf Schijns, Theresa O. Scholl, Johannes Schramm, Andreas Schulze‐Bonhage, Raf Sciot, Margitta Seeck, L V Shishkina, Dragoslav Sokić, Nicola Specchio, Tom Theys, Maria Thom, Rafael Toledano, Joseph Toulouse, Mustafa Uzan, J. van Loon, Wim Van Paesschen, Tim J. von Oertzen, Floor E. Jansen, Frans S.S. Leijten, Peter van Rijen, Wim G.M. Spliet, Angelika Mühlebner, Burkhard S. Kasper, Susanne Fauser, Tilman Polster, Thilo Kalbhenn, Daniel Delev, Andrew W. McEvoy, Anna Miserocchi, Elisabeth Landré, B. Turak, Pascale Varlet, Sarah Ferrand‐Sorbets, Martine Fohlen, Christine Bulteau, Anna Edelvik, Mukesch Shah, Christian Scheiwe, Eva Gutiérrez Delicado, Martin Tisdall, Christin Eltze, Serdar Akkol, Kaancan Deniz, Büğe Öz, Hans Holthausen, Till Hartlieb, Martin Staudt, Sara Casciato, Pier Paolo Quarato, Felice Giangaspero, Nathalie Streichenberger, Marc Guénot, Jean Isnard, Antonio Valentijn, Amanda Chang, Nandini Mullatti, Josef Zámečnı́k, Jana Zárubová, Martin Tomášek, Arto Immonen, Anni Saarela, Tuomas Rauramaa, Johannes Alexander Lobrinus, Kristóf Égervári, Shahan Momjian, Elisabeth Harti, Hannah Lohr, Judith Kroell, Lynn Vermeulen, Evy Cleeren, П А Власов, Antonia Kozlova, Alexey Vorobyev, Gudrun Goeppel, Sharon Samueli, Thomas Czech, Johannes A. Hainfellner, Gertraud Puttinger, G. Schwarz, Harald Stefanits, Serge Weis, Roberto Spreafico, Flavio Villani, L Rossini, Anke Hermsen, Susanne Knake, Christopher Nimsky, Barbara Carl, Anežka Bělohlávková, Barbora Beňová, Jeroen Bisschop, Albert Colon, Vivianne van Kranen-Mastenbroek, Rob P.W. Rouhl, Govert Hoogland, Jordi Rumià, Alia Ramírez-Camacho, Santiago Candela‐Cantó, Karine Ostrowsky‐Coste, Eleni Panagiotakaki, Alexandra Montavont, Pascale Keo Kosal, Zeynep Gokce-Samar, Clara Milleret, Anna Maria Buccoliero, Flavio Giordano, Vlatko Šulentić, Goran Mrak, Andrej Desnica, Giusy Carfì Pavia, Alessandro De Benedictis, Carlo Efisio Marras, Vladimir Baščarević, Nikola Vojvodić, Aleksandar J. Ristić, Olinda Rebelo, Ángel Aledo‐Serrano, Irene García‐Morales, Carla A. Martin,

Fetal and Pediatric Neurological Disorders

Summary Background Surgery is a widely accepted treatment option for drug-resistant focal epilepsy. A detailed analysis of longitudinal postoperative seizure outcomes and use of antiepileptic drugs for different brain lesions causing epilepsy is not available. We aimed to analyse the association between histopathology and seizure outcome and drug freedom up to 5 years after epilepsy surgery, to improve presurgical decision making and counselling. Methods In this retrospective, multicentre, longitudinal, cohort study, patients who had epilepsy surgery between Jan 1, 2000, and Dec 31, 2012, at 37 collaborating tertiary referral centres across 18 European countries of the European Epilepsy Brain Bank consortium were assessed. We included patients of all ages with histopathology available after epilepsy surgery. Histopathological diagnoses and a minimal dataset of clinical variables were collected from existing local databases and patient records. The primary outcomes were freedom from disabling seizures (Engel class 1) and drug freedom at 1, 2, and 5 years after surgery. Proportions of individuals who were Engel class 1 and drug-free were reported for the 11 main categories of histopathological diagnosis. We analysed the association between histopathology, duration of epilepsy, and age at surgery, and the primary outcomes using random effects multivariable logistic regression to control for confounding. Findings 9147 patients were included, of whom seizure outcomes were available for 8191 (89·5%) participants at 2 years, and for 5577 (61·0%) at 5 years. The diagnoses of low-grade epilepsy associated neuroepithelial tumour (LEAT), vascular malformation, and hippocampal sclerosis had the best seizure outcome at 2 years after surgery, with 77·5% (1027 of 1325) of patients free from disabling seizures for LEAT, 74·0% (328 of 443) for vascular malformation, and 71·5% (2108 of 2948) for hippocampal sclerosis. The worst seizure outcomes at 2 years were seen for patients with focal cortical dysplasia type I or mild malformation of cortical development (50·0%, 213 of 426 free from disabling seizures), those with malformation of cortical development-other (52·3%, 212 of 405 free from disabling seizures), and for those with no histopathological lesion (53·5%, 396 of 740 free from disabling seizures). The proportion of patients being both Engel class 1 and drug-free was 0–14% at 1 year and increased to 14–51% at 5 years. Children were more often drug-free; temporal lobe surgeries had the best seizure outcomes; and a longer duration of epilepsy was associated with reduced chance of favourable seizure outcomes and drug freedom. This effect of duration was evident for all lesions, except for hippocampal sclerosis. Interpretation Histopathological diagnosis, age at surgery, and duration of epilepsy are important prognostic factors for outcomes of epilepsy surgery. In every patient with refractory focal epilepsy presumed to be lesional, evaluation for surgery should be considered. Funding None.