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Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study
BACKGROUND: Increased seizure frequency and new-onset tonic-clonic seizures (TCS) have been reported after epilepsy surgery. OBJECTIVE: To analyze potential risk factors for these outcomes in a large cohort. METHODS: We studied prospectively collected data in the Swedish National Epilepsy Surgery Re...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490157/ https://www.ncbi.nlm.nih.gov/pubmed/31792497 http://dx.doi.org/10.1093/neuros/nyz488 |
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author | Bjellvi, Johan Edelvik Tranberg, Anna Rydenhag, Bertil Malmgren, Kristina |
author_facet | Bjellvi, Johan Edelvik Tranberg, Anna Rydenhag, Bertil Malmgren, Kristina |
author_sort | Bjellvi, Johan |
collection | PubMed |
description | BACKGROUND: Increased seizure frequency and new-onset tonic-clonic seizures (TCS) have been reported after epilepsy surgery. OBJECTIVE: To analyze potential risk factors for these outcomes in a large cohort. METHODS: We studied prospectively collected data in the Swedish National Epilepsy Surgery Register on increased seizure frequency and new-onset TCS after epilepsy surgery 1990-2015. RESULTS: Two-year seizure outcome was available for 1407 procedures, and data on seizure types for 1372. Increased seizure frequency at follow-up compared to baseline occurred in 56 cases (4.0%) and new-onset TCS in 53 (3.9%; 6.6% of the patients without preoperative TCS). Increased frequency was more common in reoperations compared to first surgeries (7.9% vs 3.1%; P = .001) and so too for new-onset TCS (6.7% vs 3.2%; P = .017). For first surgeries, binary logistic regression was used to analyze predictors for each outcome. In univariable analysis, significant predictors for increased seizure frequency were lower age of onset, lower age at surgery, shorter epilepsy duration, preoperative neurological deficit, intellectual disability, high preoperative seizure frequency, and extratemporal procedures. For new-onset TCS, significant predictors were preoperative deficit, intellectual disability, and nonresective procedures. In multivariable analysis, independent predictors for increased seizure frequency were lower age at surgery (odds ratio (OR) 0.70 per increasing 10-yr interval, 95% CI 0.53-0.93), type of surgery (OR 0.42 for temporal lobe resections compared to other procedures, 95% CI 0.19-0.92), and for new-onset TCS preoperative neurological deficit (OR 2.57, 95% CI 1.32-5.01). CONCLUSION: Seizure worsening is rare but should be discussed when counseling patients. The identified risk factors may assist informed decision-making before surgery. |
format | Online Article Text |
id | pubmed-7490157 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-74901572020-09-21 Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study Bjellvi, Johan Edelvik Tranberg, Anna Rydenhag, Bertil Malmgren, Kristina Neurosurgery Research—Human—Clinical Studies BACKGROUND: Increased seizure frequency and new-onset tonic-clonic seizures (TCS) have been reported after epilepsy surgery. OBJECTIVE: To analyze potential risk factors for these outcomes in a large cohort. METHODS: We studied prospectively collected data in the Swedish National Epilepsy Surgery Register on increased seizure frequency and new-onset TCS after epilepsy surgery 1990-2015. RESULTS: Two-year seizure outcome was available for 1407 procedures, and data on seizure types for 1372. Increased seizure frequency at follow-up compared to baseline occurred in 56 cases (4.0%) and new-onset TCS in 53 (3.9%; 6.6% of the patients without preoperative TCS). Increased frequency was more common in reoperations compared to first surgeries (7.9% vs 3.1%; P = .001) and so too for new-onset TCS (6.7% vs 3.2%; P = .017). For first surgeries, binary logistic regression was used to analyze predictors for each outcome. In univariable analysis, significant predictors for increased seizure frequency were lower age of onset, lower age at surgery, shorter epilepsy duration, preoperative neurological deficit, intellectual disability, high preoperative seizure frequency, and extratemporal procedures. For new-onset TCS, significant predictors were preoperative deficit, intellectual disability, and nonresective procedures. In multivariable analysis, independent predictors for increased seizure frequency were lower age at surgery (odds ratio (OR) 0.70 per increasing 10-yr interval, 95% CI 0.53-0.93), type of surgery (OR 0.42 for temporal lobe resections compared to other procedures, 95% CI 0.19-0.92), and for new-onset TCS preoperative neurological deficit (OR 2.57, 95% CI 1.32-5.01). CONCLUSION: Seizure worsening is rare but should be discussed when counseling patients. The identified risk factors may assist informed decision-making before surgery. Oxford University Press 2019-12-03 /pmc/articles/PMC7490157/ /pubmed/31792497 http://dx.doi.org/10.1093/neuros/nyz488 Text en © Congress of Neurological Surgeons 2019. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Research—Human—Clinical Studies Bjellvi, Johan Edelvik Tranberg, Anna Rydenhag, Bertil Malmgren, Kristina Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study |
title | Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study |
title_full | Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study |
title_fullStr | Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study |
title_full_unstemmed | Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study |
title_short | Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study |
title_sort | risk factors for seizure worsening after epilepsy surgery in children and adults: a population-based register study |
topic | Research—Human—Clinical Studies |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490157/ https://www.ncbi.nlm.nih.gov/pubmed/31792497 http://dx.doi.org/10.1093/neuros/nyz488 |
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