REOPERATION FOR EPILEPSY. A 10 [ndash]YEAR REPORT (1990 [ndash] 1999) FROM THE SWEDISH NATIONAL EPILEPSY SURGERY REGISTER
Abstract number :
H.05
Submission category :
Year :
2002
Submission ID :
1828
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Bertil Rydenhag, Kristina Malmgren, Ingrid Olsson, Hans C:son Silander, Roland Flink. Epilepsy research unit, Institute of Clinical Neuroscience, Göteborg, Sweden; Department of Neuropediatrics, Institute for the Health of Women and Children, Göteborg, Sw
RATIONALE: To report outcome data following reoperation for pharmacoresistant epilepsy using the Swedish National Epilepsy Surgery Register.
METHODS: Epilepsy surgery in Sweden is performed at six centres and data on all procedures are collected in a national register. This study includes 83 resective reoperations performed 1990 - 1999, and with two year follow up data available. The outcome data will be presented in relation to the postoperatively defined pathological-anatomical diagnoses. Gangliogliomas (n=6), DNET (n=4), low grade astrocytomas (n=8) and two cavernous hemangiomas constitute a lesion group. The remaining temporal (n=33) and extratemporal (n=17) resections had diagnoses such as gliosis or malformations. Multilobe (n=4) and subtotal hemispherectomy reoperations (n=2) are grouped together, while complete hemispherectomies (n=7) are reported separately.
RESULTS: Reoperations for pathologically verified lesions were performed in 20 cases, 60 % of the patients became seizure free and 5% had [gt] 75 % reduction of seizure frequency. If only ganglioglioma and DNET were grouped (n=10) 70 % of the patients became seizurefree and 10 % had [gt] 75 % reduction of seizure frequency following reoperation. The temporal lobe reoperations rendered 24 % of the patients seizure free and 18 % had [gt]75% reduction of seizure frequency. Extratemporal reoperations in a single lobe rendered 24 % of the patients seizure free and 12 % had [gt] 75 % reduction of seizure frequency. The multilobe and subtotal hemispherectomy reoperations rendered 16 % (n=1) of the patients seizure free and 16 % (n=1) had [gt] 75 % reduction of seizure frequency. The complete hemispherectomies performed as a reoperation rendered by contrast 71 % of the patients seizure free, the other 29 % had no benefit.
CONCLUSIONS: The data from the Swedish National Epilepsy Surgery Register shows that reoperations for pharmacoresistant epilepsy in general has a worse outcome than the primary surgery. However, reoperations for residual lesions is highly beneficial. Especially ganglioglioma and DNET residuals should be considered for reoperation if seizures persist. It is also our view that total hemispherectomy as a reoperation is a different entity, since this procedure is sometimes performed as a staged procedure, with an initial callosotomy or multilobe resection. The outcome in this group is as good as expected for a primary procedure.
[Supported by: The Medical Faculty of the University of Göteborg]