WASHINGTON – Resective epilepsy surgery yielded favorable long-term outcomes with respect to both seizure frequency and psychosocial factors in the majority of adult patients who participated in a recent survey.
Of 253 respondents, 82 (32%) were free of seizures at a mean of 10.6 years after surgery, and 189 (75%) had a favorable outcome, defined as Engel’s Class I or II surgery outcome, Dr. Marianna V. Spanaki-Varelas reported in a poster at the annual meeting of the American Epilepsy Society.
Overall, more than half (51%) of the patients were driving after surgery, compared with 35% before surgery, Dr. Spanaki-Varelas of Henry Ford Comprehensive Epilepsy Program, Detroit.
Respondents were less likely currently to be working full time when surveyed vs. prior to surgery (23% vs. 42%), but employment was greater in the 85% of patients who underwent temporal vs. extratemporal resection (45% vs. 26%).
Also, more patients were using antidepressants after surgery, compared with before surgery (30% vs. 22%).
Among the patients with favorable outcomes, 65% were driving after surgery (compared with 11% of those without a favorable outcome), 28% were currently employed, (compared with 8% of those without favorable outcomes), and only 24% were taking antidepressants (compared with 47% of those without a favorable outcome).
Perhaps most notable was that regardless of surgery site, 92% of respondents considered epilepsy surgery worthwhile, including 98% of those with a favorable outcome and 74% of those without a favorable outcome.
Even in patients without a favorable outcome, seizure frequency was often reduced and patients were satisfied, she explained, noting that the findings reinforce the importance of quality of life – and the ability of surgery to enhance quality of life, and they suggest that referral for surgery should be considered earlier in the course of treatment.
The respondents had a mean age of 46 years at the time of the survey, a mean age of nearly 16 years at epilepsy diagnosis, and a mean age of 35 years at the time of surgery, which took place at the Henry Ford Epilepsy Program between 1993 and 2011. Patient records were retrospectively reviewed, and the patients were surveyed between May 2012 and January 2013.
Nearly a third (30%) had follow-up of at least 20 years, Dr. Spanaki-Varelas noted.
It is concerning that potentially life-changing surgery is being delayed nearly 20 years for many patients, she said, noting that part of the reason for delay is the common misconception that the more medications a patient tries, the better their outcome will be. This delays evaluations for surgical intervention. Also, surveys suggest that many physicians don’t refer patients for surgical evaluation because they don’t feel confident regarding their knowledge of the risks and benefits of surgery.
These findings underscore the need for better patient education, which may improve self-referral rates, she said.