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Outcomes of multilobar resections for epilepsy in Sweden 1990–2013: a national population-based study

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Abstract

Background

Reports on outcome after multilobar resection (MLR) are scarce and most are retrospective single-centre studies or case studies with few patients. The aim of this study is to present seizure and complication outcomes 2 years after MLR in a prospective population-based series.

Method

The Swedish National Epilepsy Surgery Registry (SNESUR) provides prospective population-based data on outcome and complications after epilepsy surgery. For this study, we have analysed data on seizure outcome and complications after MLR from the SNESUR between 1990 and 2013.

Results

Fifty-seven patients underwent MLR; 40/57 surgeries were performed between 1990 and 2000. Sixteen operations were classified as partial hemispherotomy. Resections were right-sided in 33 (58 %) patients. Mean age was 17.3 years (range, 0.3-63.4 years) and mean duration of epilepsy before surgery was 11.0 years (range, 0.2-37 years). Preoperative neurological deficits were seen in 19 patients (33.3 %). Learning disability (LD) was seen in 18 patients (31.6 %), six had severe LD (IQ <50). Seizure outcome after 2 years was available for 53 patients. Thirteen (24.5 %) were seizure-free and 12 (22.6 %) had >75 % seizure frequency reduction. Three (5.3 %) patients suffered major complications: infarction of the middle cerebral artery, epidural abscess and hemiparesis. Minor complications were seen in ten patients. There was no mortality.

Conclusions

This prospective, population-based study provides data on seizure outcome and complications after MLR. In selected patients MLR can be considered, but expectations for seizure freedom should not be too high and patients and parents should be counselled appropriately.

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Authors and Affiliations

  1. Epilepsy Research Group, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden

    Daniel T. Nilsson, Kristina Malmgren & Bertil Rydenhag

  2. Department of Neurosurgery, Sahlgrenska University Hospital, Blå str 5, 3 tr, 413 45, Göteborg, Sweden

    Daniel T. Nilsson

  3. Institute of Neuroscience, Uppsala University, Uppsala, Sweden

    Roland Flink

Authors
  1. Daniel T. Nilsson
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  2. Kristina Malmgren
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  3. Bertil Rydenhag
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Corresponding author

Correspondence to Daniel T. Nilsson.

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Funding

Sahlgrenska Academy, University of Gothenburg through the LUA/ALF agreement. Grant, ALFGBG137431; recipient, Prof. Kristina Malmgren. The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Comment

The authors present with their manuscript an analysis of patient outcome after multilobar resection for epilepsy in Sweden. Only surgeries in the years 1990–2013 were included. This manuscript is based on data of the Swedish National Epilepsy Registry. A total of 57 procedures was included with most procedures been done in the first decade. Twenty-four-point-five-percent of the patient became seizure-free, 22.6 % experienced a significant reduction of seizure frequency. Complication rate reached 20 % with three major complications with permanent deficits. The authors conclude that MLR can be considered in selected patients, but expectations for seizure freedom should not be too high and patients and parents should be counselled appropriately. Although the case number is small, this is a rather large case series for multilobar resection in epilepsy. Since this is a very rare indication, all experiences should be published. Particularly since it is a registry based analysis, significant bias with interpretation of the results can be excluded. Overall the data are further discouraging and support the trend that the number of multilobar resections are declining. So in all, the indication for these procedures has to be highly selective.

Joachim Oertel

Homburg-Saar, Germany

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Nilsson, D.T., Malmgren, K., Flink, R. et al. Outcomes of multilobar resections for epilepsy in Sweden 1990–2013: a national population-based study. Acta Neurochir 158, 1151–1157 (2016). https://doi.org/10.1007/s00701-016-2807-3

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  • DOI: https://doi.org/10.1007/s00701-016-2807-3

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