How many more seizure remission can we achieve with epilepsy surgeries in a general epilepsy population?

Si-lei Fong; Kheng-seang Lim; Khine Yee Mon; Sherrini Ahmad Bazir; Chongtin Tan

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How many more seizure remission can we achieve with epilepsy surgeries in a general epilepsy population?

Author: Si-Lei Fong ¹ ; Kheng-Seang Lim ¹ ; Khine Yee Mon ² ; Sherrini Ahmad Bazir ³ ; ChongTin Tan ¹
Author Information

1. Neurology Division, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
2. Neuromedical Department, University of Medicine (1), Yangon, Myanmar
3. Subang Jaya Medical Centre, Kuala Lumpur, Malaysia
Publication Type:Journal Article
Keywords: Seizure outcome; anti-epileptic drugs; epilepsy surgery; epilepsy cohort
From:Neurology Asia 2020;25(4):467-472
CountryMalaysia
Language:English
Abstract: Background & Objective: We knew that 63.6% of the epilepsy population can be seizure free with the use of anti-epileptic drugs (AED), but are unsure how many more with epilepsy surgeries. We aimed to determine the additional remission rate achieved with epilepsy surgeries in addition to AED. Methods: We analysed the seizure outcome among epilepsy patients seen retrospectively over oneyear period in University Malaya Medical Centre, Malaysia, which provides all levels (level 1-4) of epilepsy cares, in response to anti-epileptic drug (AED) and epilepsy surgeries. The seizure outcome was categorised into remission and drug-resistant, according to ILAE definition of drug resistance. Results: There were 909 patients seen during the study period, majority with focal epilepsy (63.3%), and Chinese (37.4%). Of those, 409 (45.0%) were in seizure remission, 238 (26.2%) had drug-resistant epilepsy and 262 (28.8%) uncertain. Only the remission and drug-resistant groups (N=647) were included in subsequent analysis. The mean age of onset in drug-resistant group was 14.8±12.3 years old, which was significantly younger than the remission group (20.8±16.8, p<0.05). There were 40 (54.8%) patients who underwent resective epilepsy surgeries (10 were lesion-negative cases). The seizure freedom rate with epilepsy surgery was 60.0% (n=24). Overall, a total of 59.5% of patients were in seizure remission with AED, with an additional 3.7% with epilepsy surgery. Conclusion: There were 3.7% of epilepsy patients achieved seizure remission with epilepsy surgeries in a general epilepsy cohort in addition to AEDs.
Full text:7.2020my0068.pdf