This study looks at surgical outcome for 19 years postop, making it the largest and longest prospective study of surgical outcomes for epilepsy.
The investigators found that 70% of patients were seizure free for the last year at any time, but only 51% were completely seizure free throughout the follow-up because each year there was a 3%-15% change within the different groups of patients.
Also, simple partial seizures that occurred within 2 years of surgery were a significant risk factor for the long-term recurrence of seizures. This finding has implications for the decision to discontinue antiepileptic drugs in patients with only simple partial seizures.
This study validates the long-term effectiveness of epilepsy surgery, but it raises important questions and challenges. It makes us wonder if there are equal benefits of being seizure free among patients who have had continuous remission and those who had later remission, as well as if we can improve selection and reselection strategies to optimize long-term seizure control.
Dr. Ahmed-Ramadan Sadek of Southampton University Hospitals NHS Trust and Professor William Peter Gray of University of Southampton, both in Southampton, United Kingdom, wrote their comments in an editorial accompanying the epilepsy surgery study (Lancet 2011;378:1360-2). They reported having no conflicts of interest.
