The Irish epilepsy surgery experience: Long-term follow-up

Area of Science:

• Neurosurgery
• Epileptology
• Clinical Neurology

Background:

• Refractory epilepsy poses significant challenges for patient quality of life.
• Resective surgery is a key treatment option for drug-resistant epilepsy.
• Understanding long-term outcomes is crucial for surgical decision-making.

Purpose of the Study:

• To evaluate the long-term seizure outcomes of Irish patients undergoing resective epilepsy surgery.
• To determine the influence of specific pathologies on surgical success.
• To assess the impact of surgical techniques, particularly neocorticectomy, on seizure control.

Main Methods:

• Retrospective review of medical records, imaging, and pathology from 1975-2005.
• Inclusion of 199 patients with a minimum 1-year follow-up (mean 7.0 years).
• Classification of seizure outcomes using Engel's criteria at multiple long-term intervals.

Main Results:

• Seizure freedom rates at 2, 5, 10, and 15+ years were 56.6%, 41.4%, 44%, and 31.3% respectively.
• Pathology impacted outcomes: tumors (62.5% seizure-free at 10 years) vs. cortical dysplasia (34.8%).
• Temporal neocorticectomy showed poorer outcomes (20% Engel class 1 at 10+ years) compared to other techniques (58.5%).

Conclusions:

• Long-term seizure freedom rates in Irish patients align with international retrospective studies.
• Selective surgical procedures generally yielded better outcomes than lobar resections.
• The Irish-specific temporal neocorticectomy technique demonstrated the poorest long-term seizure control.