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In this study, the authors took advantage of their large group of 76 adults and 82 children undergoing frontal lobe epilepsy surgery to determine which clinical variables affect long-term outcomes. All patients underwent frontal lobe resections with a minimum postoperative follow-up of 6 months; 83% had more than 1 year of follow-up (mean, 4.3 years). Mean epilepsy duration was 12 years.
At last follow-up, half the patients were seizure-free. In those who were not seizure-free, median time to recurrence was 3 months; 75% had recurrence within 6 months. The most significant predictor of seizure outcome was epilepsy duration. Those with epilepsy duration ≥2 years were more than twice as likely to have seizure recurrence after surgery compared with those with epilepsy duration <2 years.
Simasathien T et al. Improved outcomes with earlier surgery for intractable frontal lobe epilepsy. Ann Neurol 2013 May; 73:646. (http://dx.doi.org/10.1002/ana.23862)
Comment
These findings support a potential association between duration of epilepsy and secondary epileptogenesis. This association may be particularly prominent among children, because the impact of seizures on a developing brain may be more detrimental. Many factors go into optimal timing of surgical intervention for any type of epilepsy, but this study supports the notion of early referral to an epilepsy center where appropriate presurgical testing can be performed to determine if surgery is an option. These test results should be incorporated into counseling that balances the chances of a spontaneous remission during ongoing medical management against the potential impact of delaying surgery.