Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Member of the ERN EpiCARE, Brno, Czech Republic.
Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Member of the ERN EpiCARE, Brno, Czech Republic.
Epilepsia Open. 2023 Sep;8(3):991-1001. doi: 10.1002/epi4.12769. Epub 2023 Jun 8.
We analyzed trends in patients' characteristics, outcomes, and waiting times over the last 25 years at our epilepsy surgery center situated in Central Europe to highlight possible areas of improvement in our care for patients with drug-resistant epilepsy.
A total of 704 patients who underwent surgery at the Brno Epilepsy Center were included in the study, 71 of those were children. Patients were separated into three time periods, 1996-2000 (n = 95), 2001-2010 (n = 295) and 2011-2022 (n = 314) based on first evaluation at the center.
The average duration of epilepsy before surgery in adults remained high over the last 25 years (20.1 years from 1996 to 2000, 21.3 from 2001 to 2010, and 21.3 from 2011 to 2020, P = 0.718). There has been a decrease in rate of surgeries for temporal lobe epilepsy in the most recent time period (67%-70%-52%, P < 0.001). Correspondingly, extratemporal resections have become more frequent with a significant increase in surgeries for focal cortical dysplasia (2%-8%-19%, P < 0.001). For resections, better outcomes (ILAE scores 1a-2) have been achieved in extratemporal lesional (0%-21%-61%, P = 0.01, at least 2-year follow-up) patients. In temporal lesional patients, outcomes remained unchanged (at least 77% success rate). A longer duration of epilepsy predicted a less favorable outcome for resective procedures (P = 0.024) in patients with disease duration of less than 25 years.
The spectrum of epilepsy surgery is shifting toward nonlesional and extratemporal cases. While success rates of extratemporal resections at our center are getting better, the average duration of epilepsy before surgical intervention is still very long and is not improving. This underscores the need for stronger collaboration between epileptologists and outpatient neurologists to ensure prompt and effective treatment for patients with drug-resistant epilepsy.
我们分析了过去 25 年来我们位于中欧的癫痫外科中心患者特征、结局和等待时间的趋势，以突出我们在治疗耐药性癫痫患者方面可能需要改进的领域。
共有 704 名在布尔诺癫痫中心接受手术的患者被纳入研究，其中 71 名为儿童。患者根据首次在中心评估的时间被分为三个时期：1996-2000 年（n=95）、2001-2010 年（n=295）和 2011-2022 年（n=314）。
在过去的 25 年中，成人手术前癫痫的平均持续时间仍然很高（1996 年至 2000 年为 20.1 年，2001 年至 2010 年为 21.3 年，2011 年至 2020 年为 21.3 年，P=0.718）。最近一段时间，颞叶癫痫手术的比例有所下降（67%-70%-52%，P<0.001）。相应地，颞叶外切除术变得更加频繁，局灶性皮质发育不良的手术显著增加（2%-8%-19%，P<0.001）。对于切除术，颞叶病变患者的结局保持不变（至少 77%的成功率），而颞叶外病变患者的结局则有所改善（ILAE 评分 1a-2，0%-21%-61%，P=0.01，至少 2 年随访）。在疾病持续时间少于 25 年的患者中，癫痫持续时间较长预测切除手术的结果较差（P=0.024）。
癫痫手术的范围正在向非病变和颞叶外病例转移。虽然我们中心的颞叶外切除术成功率有所提高，但手术前癫痫的平均持续时间仍然很长，且没有改善。这突显了癫痫专家和门诊神经科医生之间需要更紧密的合作，以确保为耐药性癫痫患者提供及时有效的治疗。
