Long-term seizure and psychosocial outcomes of epilepsy surgery

Most results reported in studies focusing on long-term outcomes of epilepsy surgery resemble those reported in studies with shorter follow-up, indicating that many of the surgical results are enduring. In general, about 60% of patients with temporal epilepsy and 25% to 40% of those with extratemporal epilepsy achieve long-term seizure freedom after epilepsy surgery. Over a long term, about 20% of patients discontinue antiepileptic drugs, whereas 41% continue monotherapy and 31% use polytherapy. Evidence concerning the impact of epilepsy surgery on mortality is inconclusive, but some data support a reduction in the risk of death if patients become seizure-free. The information regarding long-term cognitive outcomes is limited but is similar to that derived from short-term studies. Decline in verbal memory occurs frequently after resections of the left temporal lobe; better memory outcomes are reported in seizure-free patients, and memory decline has been documented in patients with intractable epilepsy who do not undergo surgery. However, important confounders such as the effects of antiepileptic drugs, practice effects, and regression to the mean have not been adequately accounted for in these studies. All uncontrolled long-term studies report improved psychosocial outcomes with epilepsy surgery, including employment, education, driving status, satisfaction, and quality of life, but the results of the few existing controlled studies are less persuasive.