Long-term seizure, psychiatric and socioeconomic outcomes after frontal lobe epilepsy surgery

Anthony Khoo; Jane de Tisi; Jacqueline Foong; Dorothea Bindman; Aidan G O'Keeffe; Josemir W Sander; Anna Miserocchi; Andrew W McEvoy; John S Duncan

doi:10.1016/j.eplepsyres.2022.106998

Long-term seizure, psychiatric and socioeconomic outcomes after frontal lobe epilepsy surgery

Epilepsy Res. 2022 Oct:186:106998. doi: 10.1016/j.eplepsyres.2022.106998. Epub 2022 Aug 13.

Authors

Anthony Khoo¹, Jane de Tisi², Jacqueline Foong³, Dorothea Bindman³, Aidan G O'Keeffe⁴, Josemir W Sander⁵, Anna Miserocchi⁶, Andrew W McEvoy⁶, John S Duncan⁷

Affiliations

¹ Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia. Electronic address: anthony.khoo@sa.gov.au.
² Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.
³ Department of Neuropsychiatry, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
⁴ School of Mathematical Sciences, University of Nottingham, Nottingham NG7 2RD, UK.
⁵ Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, Heemstede 2103SW, Netherlands; Department of Neurology, West China Hospital, & Institute of Brain Science & Brain-inspired Technology, Sichuan University, Chengdu 610041, China.
⁶ Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
⁷ Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK.

PMID: 35985250
DOI: 10.1016/j.eplepsyres.2022.106998

Abstract

Objective: Resective surgery for selected individuals with frontal lobe epilepsy can be effective, although multimodal outcomes are less established than in temporal lobe epilepsy. We describe long-term seizure remission and relapse patterns, psychiatric comorbidity, and socioeconomic outcomes following frontal lobe epilepsy surgery.

Methods: We reviewed individual data on frontal lobe epilepsy procedures at our center between 1990 and 2020. This included the presurgical evaluation, operative details and annual postoperative seizure and psychiatric outcomes, prospectively recorded in an epilepsy surgery database. Outcome predictors were subjected to multivariable analysis, and rates of seizure freedom were analyzed using Kaplan-Meier methods. We used longitudinal assessment of the Index of Multiple Deprivation to assess change in socioeconomic status over time.

Results: A total of 122 individuals with a median follow-up of seven years were included. Of these, 33 (27 %) had complete seizure freedom following surgery, with a further 13 (11 %) having only auras. Focal MRI abnormality, histopathology (focal cortical dysplasia, cavernoma or dysembryoplastic neuronal epithelial tumor) and fewer anti-seizure medications at the time of surgery were predictive of a favorable outcome; 67 % of those seizure-free for the first 12 months after surgery never experienced a seizure relapse. Thirty-one of 50 who had preoperative psychiatric pathology noticed improved psychiatric symptomatology by two years postoperatively. New psychiatric comorbidity was diagnosed in 15 (13 %). Persistent motor complications occurred in 5 % and dysphasia in 2 %. No significant change in socioeconomic deciles of deprivation was observed after surgery.

Significance: Favorable long-term seizure, psychiatric and socioeconomic outcomes can be seen following frontal lobe epilepsy surgery. This is a safe and effective treatment that should be offered to suitable individuals early.

Keywords: Comorbid; Extratemporal; Outcome; Psychiatry.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Electroencephalography
Epilepsy, Frontal Lobe* / surgery
Epilepsy, Temporal Lobe* / surgery
Humans
Recurrence
Retrospective Studies
Socioeconomic Factors
Treatment Outcome