Aug 2026· Epilepsy Currents· 0 citations· 9 references
Medicine
TL;DR
The goal was to analyze the outcomes of patients undergoing epilepsy surgery at the authors' center, with a minimum follow-up of 15 years, and found Appropriate referral to a refractory epilepsy center permits a multidisciplinary approach that can result in long-term seizure freedom for most patients undergoing surgery.
Abstract
Long-term outcomes of epilepsy surgery: A 25-year experience from a tertiary referral center Almeida M, Barros F, Cunha I, Brás A, Teotónio R, Bento C, Sales F. Epileptic Disord. 2025 Dec;27(6):1217-1226. doi: 10.1002/epd2.70101. Epub 2025 Sep 6. PMID: 40913513; PMCID: PMC12747684. Objective: Despite pharmacological advances in epilepsy treatment, one-third of patients remain pharmacoresistant and may require surgery. Despite extensive literature on epilepsy surgery, studies with follow-ups longer than 5 years are rare. Our goal was to analyze the outcomes of patients undergoing epilepsy surgery at our center, with a minimum follow-up of 15 years. Methods: This was a retrospective study of prospectively collected data. We used the Engel classification to assess seizure freedom, performed univariate descriptive analysis of the variables of interest, and applied appropriate correlation tests for nominal and categorical variables, with statistical significance set at 0.05. Results: We included 160 patients with a minimum follow-up of 15 years. A total of 105 (70%) patients underwent resective surgeries, the most common being lesionectomy (46.7%), followed by anterior temporal lobectomy with amygdalectomy (21.9%). Among resective surgeries, 73.6% used intraoperative ECOG. Most surgeries were in the temporal lobe (68.8%), and mesial sclerosis was the most frequent etiology (33.8%), followed by long-term epilepsy-associated tumors (LEAT) (25.6%). Seizure freedom at 15 years was achieved by 57.5% of patients, and most of the remaining patients (63.2%) had rare disabling seizures. The majority (65%) discontinued at least 1 ASM. Temporal surgeries (χ2(1) = 8.444, P < .05), left-sided surgeries (χ2(1) = 6.436, P = .04), mesial sclerosis (χ2(1) = 50.870, P = .024), and the use of intraoperative ECOG (χ2(1) = 23.235, P < .001) were associated with a better prognosis. No differences in outcome were found between the different temporal lobe surgeries (Fisher's exact test value=0.859, P = .659). Significance: Appropriate referral to a refractory epilepsy center permits a multidisciplinary approach that can result in long-term seizure freedom for most patients undergoing surgery, especially for left-temporal lobe surgeries performed with the aid of intraoperative monitoring techniques.
Underutilization persists as a major and partly remediable problem, and the welcome diffusion of minimally invasive options should not eclipse resective and disconnective surgery, which remain the only potentially curative options validated by RCTs.
It is suggested that establishing routine FLE services in countries with limited resources is feasible, and a streamlined surgery pathway should be introduced, together with strengthening national capacity and adopting cost-efficient technology.
Zainal Muttaqin, J. Bunyamin, Novanda Rizky Radityatama et al.· Surgical neurology internati...· 0 citations
INTRODUCTION
Benign epileptiform variants (BEV) are uncommon epileptiform-like EEG graphoelements that do not meet diagnostic criteria for epileptiform or pathological discharges. The clinical significance of some subtypes remains uncertain.
METHODS
We conducted a single-centre, retrospective, observational study of 57 408 EEG recordings from 32 349 patients who were followed up for more than one year. We determined the prevalence of each BEV and compared the presence of epilepsy at baseline and at the end of follow-up.
RESULTS
BEV were identified in 192 patients (287 EEG recordings), yielding a prevalence of 0.58% in the total cohort and 1.26% among patients with otherwise normal EEG recordings (n = 15 172). Diagnosis of epilepsy was observed in 39% of patients with BEV at baseline and 35% of patients with BEV after a mean follow-up of 7.4 years. In subtype-based analyses, the 6-Hz spike-and-wave bursts subtype was significantly associated with a higher prevalence of epilepsy at baseline (OR: 12.3; 95% CI, 1.47-103.2; P = .021), and the small sharp spikes variant was associated with a higher prevalence of focal epilepsy at the end of follow-up (OR: 3.05; 95% CI, 1.43-6.50; P = .004), as compared to other BEV. In contrast, wicket spikes were associated with a lower presence of epilepsy (OR: 0.31; 95% CI, 0.13-0.72; P = .007) than other BEV.
CONCLUSIONS
BEV are infrequent, heterogeneous EEG findings. Correct recognition, particularly of wicket spikes, may prevent overdiagnosis and unnecessary treatment. Overall, they lack pathological significance, although 6-Hz spike-and-wave bursts and small sharp spikes showed a stronger association with epilepsy and may be considered variants of uncertain significance warranting clinical follow-up.
R. A. S. Díaz, S. B. Cuéllar, Jesús González de la Aleja Tejera et al.· Neurología· 0 citations
Low diagnostic yield of presurgical genetic testing in adult patients with epilepsy Jünemann C, Stuart A, Kaur N, Wiebe S, Jette N, Singh S, Borlot F, Knake S; Calgary Comprehensive Epilepsy Program Collaborators; Billie Au PY, Klein KM. Epilepsia. 2026 May 20. doi: 10.1002/epi.70291. Epub ahead of print. PMID: 42157695. Objective: To determine the diagnostic yield of genetic testing in patients undergoing presurgical evaluation for epilepsy. Methods: We conducted a cohort study including 115 adult patients who underwent presurgical evaluation in the Calgary Epilepsy Program between 2019 and 2023 and who had undergone research exome sequencing. A curated epilepsy gene panel comprising 765 Online Mendelian Inheritance in Man (OMIM)-listed epilepsy-associated genes was applied. Variants were classified according to American College of Medical Genetics and Genomics guidelines and assessed for clinical relevance and association with postsurgical outcomes. Results: Pathogenic or likely pathogenic variants in DEPDC5, NPRL2, KCNT2, and PRRT2 were identified, respectively, in 4 individuals (3.5%, 4/115). All variants met stringent quality criteria with high pathogenicity scores (Combined Annotation Dependent Depletion (CADD) 34–37) and absent or extremely low population frequencies in gnomAD v4.1. None of these patients had intellectual disability, and only 1 patient (PRRT2) had a positive family history. The patient with the KCNT2 variant underwent epilepsy surgery with good outcome (Engel class ID). Significance: This presurgical cohort demonstrates a low diagnostic yield of genetic testing in adult epilepsy surgery candidates. However, 3 of 4 patients with (likely) pathogenic variants did not have features that would have prompted clinical genetic testing, indicating that their genetic diagnosis would have been missed based on typical clinical genetic testing criteria in many jurisdictions.
Similar children evaluated at different institutions had significant differences in the odds of not being recommended surgery, suggesting that institutional decision-making contributes importantly to surgical candidacy.
A. Caraway, Nancy A Mcnamara, Andrew T. Knox et al.· Epilepsia· 0 citations
Palliative surgical procedures for pediatric DRE are safe and associated with seizure reduction, decreased medication burden, and gradual improvement in adaptive functioning and early surgical intervention may help minimize developmental decline and improve long-term adaptive outcomes.
Ana Valeria Duarte Oliveira, H. Machado, Ú. Thomé et al.· Child's Nervous System· 0 citations
