TY - JOUR
T1 - Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis
T2 - a retrospective multicentre cohort study
AU - Lamberink, Herm J.
AU - Otte, Willem M.
AU - Bluemcke, Ingmar
AU - Braun, Kees P. J.
AU - European Epilepsy Brain Bank writing group
AU - study group
AU - European Reference Network EpiCARE
AU - Schijns, Olaf
AU - Beckervordersandforth, Jan
N1 - Funding Information:
We acknowledge the European Reference Network EpiCARE for their support to the European Epilepsy Brain Bank (grant agreement #769501). Members of the writing group were supported by the Epilepsiefonds (WAR 08-10, to HJL); NWO (VENI 016.168.038, to WMO); EU (FP7 DESIRE GA grant 602531, to IB, RS, RG, and CB; FP7 EPITARGET GA grant 602102, to AB and EA; FP7 EPISTOP grant 602391, to EA; and FP7 EpimiRNA GA grant 602130, to HH, KMK, and FR); the Detlev-Wrobel-Fonds for Epilepsy Research to FR; Deutsche Forschungsgemeinschaft (German Research Council, Bonn, Germany) and Gerd-Altenhof-Stiftung (Deutsches Stiftungs-Zentrum, Essen, Germany) to CGB; BONFOR and Novartis Stiftung für therapeutische Forschung to AG, the Austrian Science Fund (FWF grant J3499 to AM); the Italian Ministry of Health (grant RF-2016-02362195 to RG, and grant RF-2010-2309954 to CB); the Associazione Paolo Zorzi per le Neuroscienze to FV and FD; the Swedish state under the agreement between the Swedish Government and the county councils, the ALF-agreement (grant ALFGBG-723151 to BR and KM) and the Margarethahemmet foundation (to BR and KM); Swiss National Foundation (grant 163398 and 180365 to MS); the National Institute for Health Research University College London Hospitals Biomedical Research Centre (support to MT, JSD, JDT, AM and AM); Great Ormond Street Hospital Children's Charity, the Brain Tumour Charity, Children with Cancer, Higher Education Funding Council for England, and the National Institute for Health Research (support to TSJ); National Institute for Health Research University College London Great Ormond Street Institute of Child Health Biomedical Research Centre (support to TSJ and JHC); the Anniversary Fund of the Central Bank of the Republic of Austria (grant ÖNB-12036, to MF); and Fundación Gmp (support to AG-N); Grant NV19-04-00369 (to PK, PM, JZ, BB, AB, MK, and AK); Netherlands Organisation for Health Research and Development, ZonMW, Programma Translationeel Onderzoek (project number: 95105004, to KPJB and EA).
Funding Information:
We acknowledge the European Reference Network EpiCARE for their support to the European Epilepsy Brain Bank (grant agreement #769501). Members of the writing group were supported by the Epilepsiefonds (WAR 08-10, to HJL); NWO (VENI 016.168.038, to WMO); EU (FP7 DESIRE GA grant 602531, to IB, RS, RG, and CB; FP7 EPITARGET GA grant 602102, to AB and EA; FP7 EPISTOP grant 602391, to EA; and FP7 EpimiRNA GA grant 602130, to HH, KMK, and FR); the Detlev-Wrobel-Fonds for Epilepsy Research to FR; Deutsche Forschungsgemeinschaft (German Research Council, Bonn, Germany) and Gerd-Altenhof-Stiftung (Deutsches Stiftungs-Zentrum, Essen, Germany) to CGB; BONFOR and Novartis Stiftung f?r therapeutische Forschung to AG, the Austrian Science Fund (FWF grant J3499 to AM); the Italian Ministry of Health (grant RF-2016-02362195 to RG, and grant RF-2010-2309954 to CB); the Associazione Paolo Zorzi per le Neuroscienze to FV and FD; the Swedish state under the agreement between the Swedish Government and the county councils, the ALF-agreement (grant ALFGBG-723151 to BR and KM) and the Margarethahemmet foundation (to BR and KM); Swiss National Foundation (grant 163398 and 180365 to MS); the National Institute for Health Research University College London Hospitals Biomedical Research Centre (support to MT, JSD, JDT, AM and AM); Great Ormond Street Hospital Children's Charity, the Brain Tumour Charity, Children with Cancer, Higher Education Funding Council for England, and the National Institute for Health Research (support to TSJ); National Institute for Health Research University College London Great Ormond Street Institute of Child Health Biomedical Research Centre (support to TSJ and JHC); the Anniversary Fund of the Central Bank of the Republic of Austria (grant ?NB-12036, to MF); and Fundaci?n Gmp (support to AG-N); Grant NV19-04-00369 (to PK, PM, JZ, BB, AB, MK, and AK); Netherlands Organisation for Health Research and Development, ZonMW, Programma Translationeel Onderzoek (project number: 95105004, to KPJB and EA).
Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/9
Y1 - 2020/9
N2 - 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 sderosis. 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. Copyright (C) 2020 Elsevier Ltd. All rights reserved.
AB - 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 sderosis. 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. Copyright (C) 2020 Elsevier Ltd. All rights reserved.
KW - SUCCESS
U2 - 10.1016/S1474-4422(20)30220-9
DO - 10.1016/S1474-4422(20)30220-9
M3 - Article
SN - 1474-4422
VL - 19
SP - 748
EP - 757
JO - Lancet Neurology
JF - Lancet Neurology
IS - 9
ER -