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A Pipeline for 3D Multimodality Image Integration and Computer-assisted Planning in Epilepsy Surgery
Published on: May 20, 2016
European trends in epilepsy surgery
Maxime O Baud1, Thomas Perneger1, Attila Rácz1
1From the Department of Neurology (M.O.B., S.V., F.P., M.S.), and Center for Clinical Research (T.P.), University Hospital Geneva; Department of Neurology (M.O.B.), University Hospital Bern; Wyss Center for Bio- and Neuro-Engineering (M.O.B.), Geneva, Switzerland; Klinik und Poliklinik für Epileptologie (A.R., M.C.P., C.E.), Universitätsklinikum Bonn, Germany; Sahlgrenska University Hospital and Sahlgrenska Academy at the University of Gothenburg (B.R., K. Malmgren), Sweden; UCL Great Ormond Street Hospital (J.H.C., G.M., M.T.), London, UK; Department of Child Neurology (H.J.L., K.P.J.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Department of Functional Neurology and Epileptology (S. Rheims, J.I., P.R., F.M.) and Department of Clinical Epileptology, Sleep Disorders, and Functional Neurology in Children (A.A., P.R.), Hospices Civils de Lyon and University of Lyon, France; Department of Neurology (P.R.), University Hospital Lausanne, Switzerland; Department of Neurology (S.A., K.D., C.O.), Cerrahpasa Medical Faculty, Istanbul University, Turkey; Clinic for Neuroscience (M.L.), National Center for Epilepsy, Oslo University Hospital, Norway; Epilepsy Centre, (I.R.), Masaryk University, Hospital Ste Anne, and CEITEC-Neuroscience Centre, Brno, Czech Republic; Kuopio University Hospital and University of Eastern Finland (R.K., L.-M.V.); St. Ivan Rilski University Hospital (P.D., K. Minkin), Bulgaria; Epilepsiezentrum Kork (A.M.S., B.J.S.), Germany; Second Faculty of Medicine (A.K., P.K.,, P.M.), Charles University, Motol University Hospital, Prague, Czech Republic; Juhász Pál Epilepsy Centrum (Z.J., D.F.), National Institute of Clinical Neurosciences, Hungary; Reference Center for Refractory Epilepsy (E.C., P.B.), Ghent University Hospital, Belgium; and Department of Neurology and Neurosurgery (S. Rocka, R.M.), Vilnius University, Lithuania.
Epilepsy surgery outcomes in Europe have modestly improved over 15 years, with increased surgical volume and shorter disease duration leading to better seizure freedom. Early evaluation is key for continued progress in epilepsy treatment.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Drug-resistant focal epilepsy necessitates resective surgery for effective treatment.
- The impact of diagnostic advancements on postsurgical epilepsy outcomes remains under investigation.
Purpose of the Study:
- To compare epilepsy surgery practices and outcomes between two distinct 2-year periods separated by 15 years.
- To determine if advancements in diagnostics have influenced postsurgical seizure control and complication rates.
Main Methods:
- Retrospective analysis of 1,298 pediatric and adult epilepsy surgery cases from 16 European centers (1997-1998 vs. 2012-2013).
- Collected data included patient demographics, disease characteristics, surgical procedures, histopathology, postsurgical outcomes (Engel classification), complications, and diagnostic tests.
- Multivariate logistic regression was used to identify predictors of postsurgical outcomes, with the date of surgery as a key variable.
Main Results:
- Surgical volume per center increased significantly (median 31 to 50 cases per 2-year period).
- Mean disease duration at surgery decreased by 5.2 years, and overall seizure freedom (Engel class I) improved from 66.7% to 70.9%.
- Surgeries in the later period were associated with a 1.34-fold increased likelihood of favorable outcomes, particularly in extratemporal and MRI-negative epilepsy, with stable complication rates.
Conclusions:
- Epilepsy surgery in Europe has shown modest but significant improvements over 15 years, characterized by increased surgical volume, reduced disease duration, and enhanced seizure freedom.
- These findings underscore the importance of early referral for epilepsy surgery evaluation to sustain positive treatment trends.
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