Harvard Medical School, Boston, MA, USA.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Epilepsy Res. 2024 Dec;208:107473. doi: 10.1016/j.eplepsyres.2024.107473. Epub 2024 Oct 29.
Patients considering therapeutic epilepsy surgery often seek to decrease the number of anti-seizure medications (ASMs) they need. Predicting such reductions remains challenging. Although predictors of seizure freedom after epilepsy surgery are well-established, long-term outcomes remain modest and factors associated with ASM reduction, even in the absence of seizure freedom, may improve surgical planning to align with patient goals.
We studied a large multi-institutional cohort of patients who underwent epilepsy surgery between 2001 and 2022, with a minimum of two years follow-up. Preoperative features, including duration of epilepsy, epilepsy etiology, non-invasive investigation data, and total number of ASMs prescribed immediately prior to surgery were extracted for each patient. Primary endpoints included likelihood of ASM reduction and ASM freedom at multiple post-operative time points up to 15 years and stratified by seizure control.
A total of 250 patients were followed for a median of 6.0 (range 2, 22) years after intracranial EEG (iEEG) surgery. Significant ASM reduction was only observed in those who underwent subsequent resection, whereas those undergoing neuromodulation saw their ASM usage maintained. Engel I outcomes were the strongest driver of ASM reduction. In patients with persistent seizures, patients with lateralized seizure onset zones (SOZs) also achieved sustained ASM reduction over time. Similarly, an increased number of preoperative ASMs also corresponded to a higher likelihood of ASM reduction across all follow-up periods. Other preoperative factors, including seizure etiology, did not independently influence ASM reduction.
Even patients with persistent seizures after epilepsy surgery can observe meaningful ASM reduction during long-term follow-up. ASM reduction may be a relevant secondary outcome measure for epilepsy surgery.
考虑接受治疗性癫痫手术的患者通常希望减少所需的抗癫痫药物（ASM）数量。预测这种减少仍然具有挑战性。尽管癫痫手术后无发作的预测因素已经确立，但长期结果仍然不太理想，并且与 ASM 减少相关的因素，即使在没有无发作的情况下，也可能改善手术计划，以符合患者的目标。
我们研究了一个大型多机构队列的患者，他们在 2001 年至 2022 年间接受了癫痫手术，随访时间至少为两年。为每个患者提取了术前特征，包括癫痫持续时间、癫痫病因、非侵入性检查数据和手术前开的 ASM 总数。主要终点包括在多达 15 年的多个术后时间点减少 ASM 的可能性和 ASM 自由，根据癫痫控制进行分层。
共有 250 例患者在颅内脑电图（iEEG）手术后中位数为 6.0 年（范围 2-22 年）接受了随访。只有在随后进行切除的患者中才观察到显著的 ASM 减少，而接受神经调节的患者则保持了 ASM 的使用。Engel I 结果是 ASM 减少的最强驱动因素。在持续有癫痫发作的患者中，具有侧化发作起始区（SOZ）的患者随着时间的推移也能持续减少 ASM。同样，术前 ASM 数量的增加也与所有随访期间 ASM 减少的可能性更高相对应。其他术前因素，包括癫痫病因，不能独立影响 ASM 减少。
即使在癫痫手术后仍有持续性癫痫发作的患者，在长期随访中也可以观察到 ASM 的显著减少。ASM 减少可能是癫痫手术的一个相关次要结果衡量标准。
