Researchers at Washington University School of Medicine (St. Louis, MO, USA) conducted a long term follow-up study of 361 patients who underwent epilepsy surgery by Sidney Goldring ,MD--a prominent neurosurgeon and a pioneer of epilepsy surgery--from 1967 to 1990 to date, with a mean follow-up duration of 26 years; of these, 117 (32.4%) completed follow-up interviews. The researchers gathered perioperative data and studied the seizure and health-related QOL outcomes using retrospective clinical chart reviews and follow-up surveys obtained. Seizure outcome was evaluated using the Engel classification system.

The results showed that 56 patients (48% of responders) were Engel class I, with a mean overall QOL in Epilepsy (QOLIE-31) questionnaire score of 68.2; 80% of patients reported their overall QOL as being better than before surgery. The researchers did not observe a statistically significant association between postoperative complications and long-term outcome, but patients who underwent temporal lobe resection achieved better seizure outcomes than those who underwent other types of procedures. Astatic seizures and bilateral surgery were associated with a worse Engel class outcome. The study was published early online on February 7, 2012, in Epilepsia.

“In cases where medical therapy fails to control seizures, epilepsy surgery is a safe and effective treatment option,” concluded lead author Matthew Smyth, MD, of the department of neurosurgery. “Despite the increase in the number of epilepsy surgeries performed, and reports in the medical literature of the success of surgery relative to medication, it remains an underutilized therapy for seizure control.”

The Engel classification system used to classify postoperative outcomes for epilepsy surgery is defined as Class I: Free of disabling seizures; Class II: Rare disabling seizures; Class III: Worthwhile improvement; and Class IV: No worthwhile improvement. The researchers noted that current estimations show that less than 0.1% of the more than 4 million people worldwide who could benefit from epilepsy surgery actually receive the intervention.

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Washington University School of Medicine