1.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
Neurology Asia 2020;25(4):467-472
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.