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Long-term seizure, psychiatric and socioeconomic outcomes after frontal lobe epilepsy surgery

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机构: [1]Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK [2]Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK [3]College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia [4]Department of Neuropsychiatry, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK [5]School of Mathematical Sciences, University of Nottingham, Nottingham NG7 2RD, UK [6]Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK [7]Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, Heemstede 2103SW, Netherlands [8]Department of Neurology, West China Hospital, & Institute of Brain Science & Brain-inspired Technology, Sichuan University, Chengdu 610041, China [9]Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
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关键词: Extratemporal Comorbid Psychiatry Outcome

摘要:
Resective surgery for selected individuals with frontal lobe epilepsy can be effective, although multimodal outcomes are less established than in temporal lobe epilepsy. We describe long-term seizure remission and relapse patterns, psychiatric comorbidity, and socioeconomic outcomes following frontal lobe epilepsy surgery.We reviewed individual data on frontal lobe epilepsy procedures at our center between 1990 and 2020. This included the presurgical evaluation, operative details and annual postoperative seizure and psychiatric outcomes, prospectively recorded in an epilepsy surgery database. Outcome predictors were subjected to multivariable analysis, and rates of seizure freedom were analyzed using Kaplan-Meier methods. We used longitudinal assessment of the Index of Multiple Deprivation to assess change in socioeconomic status over time.A total of 122 individuals with a median follow-up of seven years were included. Of these, 33 (27 %) had complete seizure freedom following surgery, with a further 13 (11 %) having only auras. Focal MRI abnormality, histopathology (focal cortical dysplasia, cavernoma or dysembryoplastic neuronal epithelial tumor) and fewer anti-seizure medications at the time of surgery were predictive of a favorable outcome; 67 % of those seizure-free for the first 12 months after surgery never experienced a seizure relapse. Thirty-one of 50 who had preoperative psychiatric pathology noticed improved psychiatric symptomatology by two years postoperatively. New psychiatric comorbidity was diagnosed in 15 (13 %). Persistent motor complications occurred in 5 % and dysphasia in 2 %. No significant change in socioeconomic deciles of deprivation was observed after surgery.Favorable long-term seizure, psychiatric and socioeconomic outcomes can be seen following frontal lobe epilepsy surgery. This is a safe and effective treatment that should be offered to suitable individuals early.Copyright © 2022 Elsevier B.V. All rights reserved.

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出版当年[2022]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学
最新[2023]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学
第一作者:
第一作者机构: [1]Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK [2]Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK [3]College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia [*1]Department of Neurology, Flinders Medical Centre, Bedford Park SA 5042, Australia.
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通讯机构: [1]Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK [2]Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK [3]College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia [*1]Department of Neurology, Flinders Medical Centre, Bedford Park SA 5042, Australia.
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