Coping With Epilepsy VNS Message Board
Free Advertisement
 

Go Back   Epilepsy Forum > Peer Support > Surgery Central



Reply
 
LinkBack Thread Tools
  #1  
Old 10-11-2009, 10:18 AM
Cint's Avatar
CWE Supporter
 
Join Date: May 2008
Location: Denver, CO
Posts: 5,507
Thanks: 1,153
Thanked 3,165 Times in 2,056 Posts

Seizure Recurrence Risk....


Here is interesting info for anyone considering brain surgery:

Quote :
Epilepsia 0 Suppl. 0 (Abst. 3.287 ), 2009

"SEIZURE RECURRENCE RISK AND EARLY IDENTIFICATION OF REFRACTORINESS AFTER A FIRST SEIZURE FOLLOWING EPILEPSY SURGERY

Authors: Lara Jehi, R. Sarkis, W. Bingaman, P. Kotagal and I. Najm


RATIONALE:
Patients undergoing brain surgery for intractable epilepsy anticipate a “cure”. However, up to half will have at least one seizure after surgery. Some undergo expensive re-evaluations only to regain seizure-freedom without needing further interventions, while others have recurrent seizures for years before a reoperation is explored. No evidence-based guidelines exist for their management. We aim to characterize the prognosis following a first postoperative seizure, and to provide criteria allowing early identification of recurrent refractory epilepsy.

METHODS:
Of 915 epilepsy surgery patients of all ages operated on between 1990- 2007 in a single comprehensive program, we reviewed those with at least 1 seizure beyond the immediate postoperative period, and one or more year of follow-up beyond the initial recurrence. The probability of subsequent seizures was calculated using survival analysis. Multivariate regression analysis was then used to compare seizure-free(no seizures for at least one year by last follow-up) and refractory(persistent seizures) patients.

RESULTS:
Resections were temporal (73%), frontal (17%) or in the posterior quadrant (9%). 276 patients had at least one postoperative seizure. Of those, 49% were female and 56% had left-sided surgery. The mean overall follow-up duration after surgery was 6.6 years (range 1.1-19 yrs; standard deviation 4.3) and mean follow-up after the first postoperative seizure was 5.6 years (range1.1-18.6; standard deviation 4.1). The mean timing of the first postoperative seizure was 12.1 months (median 4.6; range 0.13-114.4 months). Forty patients (14%) did not have any further recurrences, 22 had a total of 2 seizures, and 17 a total of 3 seizures by last follow-up. Ninety five patients became seizure-free, with a mean duration of seizure-freedom of 4.9 ±0.4 years (range 1.1-16.4 years) by last follow-up, and a mean interval of 17.8 (±3.1) months to achieve seizure-freedom (time from first to last postoperative seizure). The remaining 181 cases were having persistent seizures with a mean frequency of 14.4 ± 2.6seizures/month. After a first seizure, 50% had a recurrence within one month, 77% within a year before the risk slowed down to additional 2-3% increments every 2 subsequent years. After a second seizure, 50% had a recurrence within 2 weeks, 78% within 2 months, and 83% within 6 months (figure 1). Having both the first and second seizure within 6 postoperative months (odds ratio 4.04; 95% C.I. 2.05-8.40; p< 0.001), an unprovoked initial recurrence (O.R. 3.92; 95% C.I. 2.13-7.30; p< 0.001), and ipsilateral spikes on a 6-months postoperative EEG (O.R. 2.05; 95% C.I. 1.10-3.88; p= 0.02) predicted a poorer outcome, with 95% of patients having all three risk factors becoming refractory versus 32% of those with none.

CONCLUSIONS:
Seizures will recur in most patients presenting with their first postoperative event. The period of highest risk is within the few subsequent months. A third will become seizure-free with the risk for refractoriness assessed by easily ascertainable measures at 6 postoperative months."
__________________
"The Golden Rule is that there are no golden rules."
~George Bernard Shaw
Reply With Quote
  #2  
Old 10-12-2009, 08:26 AM
Super Moderator / Thank You Queen
 
Join Date: Jun 2005
Location: Massachusetts
Posts: 16,486
Thanks: 950
Thanked 7,341 Times in 5,421 Posts
That's helpful info. It must be such a tough decision to make, though if even half of the folks in the study became seizure-free, that's pretty great.
Reply With Quote
  #3  
Old 10-12-2009, 12:51 PM
epileric's Avatar
Super Moderator / Spaminator
 
Join Date: Dec 2007
Posts: 4,500
Thanks: 406
Thanked 1,308 Times in 939 Posts

Good find


Anything I've been able to find on the success of operations only followed the client up to 6 months after.
__________________
"It's no longer a question of staying healthy. It's a question of finding a sickness you like." -Jackie Mason
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are On


Similar Threads
Thread Thread Starter Forum Replies Last Post
Risk Factors Associated with Epilepsy - Part I (Alcohol, Other Drugs, Foods) brain Back Fence 43 02-04-2019 12:45 AM
Risk Factors Associated with Epilepsy - Part II (Doing Things When Advised Otherwise) brain Back Fence 59 02-04-2019 12:44 AM
Suicide Risk From 11 Epilepsy Drugs speber The Library 145 08-09-2010 11:28 PM
Risk Factors Associated with Genetics / Mitochondrial? brain The Nursery 7 04-30-2009 10:34 AM
Epilepsy linked with Type 1 diabetes risk Bernard The Library 14 10-06-2006 09:01 AM


All times are GMT -5. The time now is 07:34 PM.


Powered by vBulletin® - Copyright ©2000 - 2019, Jelsoft Enterprises Ltd.
Content Relevant URLs by vBSEO ©2009, Crawlability, Inc.
Copyright 2005 © Measuring Up. ALL rights reserved.