Outcome of epilepsy surgery in lesional epilepsy: Experiences from a developing country

Abstract

Background: Our aim was to report the postoperative seizure outcome and associated factors in patients with lesional epilepsy, in a low-income setting. Methods: This longitudinal prospective study included patients who underwent epilepsy surgery at Kashani Comprehensive Epilepsy Center between 2014 and 2019. Post-surgical outcomes were reported according to the Engel score, and patients were classified into two groups of seizure free (SF) and not seizure free (NSF). Results: A total of 148 adult patients, with a mean age of 30.45 +/- 9.23 years were included. The SF outcome was reported in 86.5 of patients and antiepileptic drugs (AEDs) were reduced or discontinued in 45.9. The mean follow-up duration was 26.7 +/- 14.9 months. Temporal lobe lesions (76.3) and mesial temporal sclerosis (MTS) (56.7) were the most frequent etiologies. Temporal lesion (Incidence relative risk (IRR): 1.76, 95 CI 1.08-2.87, p = 0.023), prior history of CNS infection (IRR:1.18, 95% CI 1.03-1.35, p = 0.019), use of intra-operative ECoG (IRR:1.73, 95% CI 1.06-2.81, p = 0.028), and absence of IEDs in postoperative EEG (IRR: 1.41, 95% CI 1.18-1.70, p < 0.001) were positive predictors for a favorable outcome. Conclusion: Many patients with drug-resistant lesional epilepsy showed a favorable response to surgery. We believe that resective epilepsy surgery in low-income settings is a major treatment option. The high frequency of patients with drug-resistant epilepsy in developing countries is associated with high rates of morbidity and mortality. Hence, strategies to increase access to epilepsy surgery in these settings are urgently needed. (c) 2021 Elsevier Inc. All rights reserved.