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Meta-Analysis
. 2019 Jun 25;6(6):CD010541.
doi: 10.1002/14651858.CD010541.pub3.

Surgery for epilepsy

Siobhan West  1 , Sarah J Nevitt, Jennifer Cotton, Sacha Gandhi, Jennifer Weston, Ajay Sudan, Roberto Ramirez, Richard Newton
Affiliations
Meta-Analysis

Surgery for epilepsy

Siobhan West et al. Cochrane Database Syst Rev. .

Abstract

Background: This is an updated version of the original Cochrane review, published in 2015.Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary between at least 20% and up to 70%. If the epileptogenic zone can be located, surgical resection offers the chance of a cure with a corresponding increase in quality of life.

Objectives: The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.Secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence, and to identify the factors that correlate with remission of seizures postoperatively.

Search methods: For the latest update, we searched the following databases on 11 March 2019: Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to March 08, 2019), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP).

Selection criteria: Eligible studies were randomised controlled trials (RCTs) that included at least 30 participants in a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), with an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome related to postoperative seizure control. Cohort studies or case series were included in the previous version of this review.

Data collection and analysis: Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportions of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RRs) and 95% confidence intervals (95% CIs).

Main results: We identified 182 studies with a total of 16,855 included participants investigating outcomes of surgery for epilepsy. Nine studies were RCTs (including two that randomised participants to surgery or medical treatment (99 participants included in the two trials received medical treatment)). Risk of bias in these RCTs was unclear or high. Most of the remaining 173 non-randomised studies followed a retrospective design. We assessed study quality using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses, we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across domains.In terms of freedom from seizures, two RCTs found surgery (n = 97) to be superior to medical treatment (n = 99); four found no statistically significant differences between anterior temporal lobectomy (ATL) with or without corpus callosotomy (n = 60), between subtemporal or transsylvian approach to selective amygdalohippocampectomy (SAH) (n = 47); between ATL, SAH and parahippocampectomy (n = 43) or between 2.5 cm and 3.5 cm ATL resection (n = 207). One RCT found total hippocampectomy to be superior to partial hippocampectomy (n = 70) and one found ATL to be superior to stereotactic radiosurgery (n = 58); and another provided data to show that for Lennox-Gastaut syndrome, no significant differences in seizure outcomes were evident between those treated with resection of the epileptogenic zone and those treated with resection of the epileptogenic zone plus corpus callosotomy (n = 43). We judged evidence from the nine RCTs to be of moderate to very low quality due to lack of information reported about the randomised trial design and the restricted study populations.Of the 16,756 participants included in this review who underwent a surgical procedure, 10,696 (64%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to recording of adverse events to be very poor.In total, 120 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography, history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection, and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation, and presence of postoperative discharges were prognostic factors of outcome.Twenty-nine studies reported multi-variable models of prognostic factors, and showed that the direction of association of factors with outcomes was generally the same as that found in univariate analyses.We observed variability in many of our analyses, likely due to small study sizes with unbalanced group sizes and variation in the definition of seizure outcome, the definition of prognostic factors, and the influence of the site of surgery AUTHORS' CONCLUSIONS: Study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcomes. Future research should be of high quality, follow a prospective design, be appropriately powered, and focus on specific issues related to diagnostic tools, the site-specific surgical approach, and other issues such as extent of resection. Researchers should investigate prognostic factors related to the outcome of surgery via multi-variable statistical regression modelling, where variables are selected for modelling according to clinical relevance, and all numerical results of the prognostic models are fully reported. Journal editors should not accept papers for which study authors did not record adverse events from a medical intervention. Researchers have achieved improvements in cancer care over the past three to four decades by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.

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Conflict of interest statement

SW has no interests to declare.

SN has no interests to declare.

JC has no interests to declare.

SG has no interests to declare.

AS has no interests to declare.

JW has no interests to declare.

RR has no interests to declare.

RN has no interests to declare.

Figures

1
1
Study flow diagram (original review: randomised controlled trials (RCTs) and non‐randomised studies (NRSs) included).
2
2
Study flow diagram (2019 update: randomised controlled trials (RCTs) only included).
3
3
Forest plot of comparison: 1 Surgery for Epilepsy, outcome: 1.1 Proportion with a good outcome of surgery.
4
4
Funnel plot of comparison: 1 Surgery for epilepsy, outcome: 1.1 Proportion with a good outcome of surgery.
1.1
1.1. Analysis
Comparison 1 Surgery versus medical treatment (randomised evidence), Outcome 1 Proportion free from seizures at 1 year.
1.2
1.2. Analysis
Comparison 1 Surgery versus medical treatment (randomised evidence), Outcome 2 Proportion free from all seizures (including auras) at 1 year.
2.1
2.1. Analysis
Comparison 2 Comparison of surgical techniques (randomised evidence), Outcome 1 Parahippocampectomy (PHC) or anterior temporal lobectomy (ATL): Proportion free from seizures (Engel Class Scale).
2.2
2.2. Analysis
Comparison 2 Comparison of surgical techniques (randomised evidence), Outcome 2 Parahippocampectomy (PHC) or Selective Amygdalohippocampectomy (SAH): Proportion free from seizures (Engel Class Scale).
2.3
2.3. Analysis
Comparison 2 Comparison of surgical techniques (randomised evidence), Outcome 3 Selective Amygdalohippocampectomy (SAH) or Anterior Temporal Lobectomy (ATL): Proportion free from seizures (Engel Class Scale).
2.4
2.4. Analysis
Comparison 2 Comparison of surgical techniques (randomised evidence), Outcome 4 Stereotactic radiosurgery (SRS) or anterior temporal lobectomy (ATL): proportion with remission of seizures (at least Engel Class IB) between 25 and 36 months.
2.5
2.5. Analysis
Comparison 2 Comparison of surgical techniques (randomised evidence), Outcome 5 Resection with or without corpus callosotomy (CCT): Proportion free from seizures (Engel Class 1).
2.6
2.6. Analysis
Comparison 2 Comparison of surgical techniques (randomised evidence), Outcome 6 Anterior temporal lobectomy (ATL) with or without corpus callosotomy (CCT): Proportion free from seizures (Engel Class 1) at 2 years.
2.7
2.7. Analysis
Comparison 2 Comparison of surgical techniques (randomised evidence), Outcome 7 Subtemporal or transsylvian selective amygdalohippocampectomy (SAH): Proportion free from all seizures (including auras, ILAE 1a) at 1 year.
2.8
2.8. Analysis
Comparison 2 Comparison of surgical techniques (randomised evidence), Outcome 8 Total or partial hippocampectomy: Proportion free from all seizures (including auras) at 1 year.
2.9
2.9. Analysis
Comparison 2 Comparison of surgical techniques (randomised evidence), Outcome 9 Length of resection (2.5 or 3.5 cm): Proportion free from seizures (Engel Class 1) at 1 year.
3.1
3.1. Analysis
Comparison 3 Surgery for epilepsy (randomised and non‐randomised evidence), Outcome 1 Proportion with a good outcome of surgery.
4.1
4.1. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 1 Good outcome by MRI results.
4.2
4.2. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 2 Good outcome by use of intracranial monitoring (IM).
4.3
4.3. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 3 Good outcome by presence of mesial temporal sclerosis (MTS).
4.4
4.4. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 4 Good outcome by concordance of pre‐op MRI and EEG.
4.5
4.5. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 5 Good outcome by history of febrile seizures (FS).
4.6
4.6. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 6 Good outcome by history of head injury (HI).
4.7
4.7. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 7 Good outcome by presence of encephalomalacia.
4.8
4.8. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 8 Good outcome by presence of focal cortical dysplasia (FCD)/malformation of cortical development (MCD).
4.9
4.9. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 9 Good outcome by presence of tumour.
4.10
4.10. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 10 Good outcome by presence of vascular malformation.
4.11
4.11. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 11 Good outcome by unilateral or bilateral interictal spikes.
4.12
4.12. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 12 Good outcome by extent of resection.
4.13
4.13. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 13 Good outcome by extent of resection.
4.14
4.14. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 14 Good outcome by side of surgical resection.
4.15
4.15. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 15 Good outcome by side of surgical resection.
4.16
4.16. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 16 Good outcome by presence of postoperative discharges.
4.17
4.17. Analysis
Comparison 4 Prognostic factors of a good outcome of surgery (randomised and non‐randomised evidence), Outcome 17 Good outcome by presence of postoperative discharges.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Velasco 2011 {published data only}
    1. Velasco TR, Wichert‐Ana L, Mathern GW, Araújo D, Walz R, Bianchin MM, et al. Utility of ictal single photon emission computed tomography in mesial temporal lobe epilepsy with hippocampal atrophy: a randomized trial. Neurosurgery 2011;68:431‐6. - PubMed
Vogt 2018 {published data only}
    1. Delev D, Wabbels B, Schramm J, Nelles M, Elger CE, Lehe M, et al. Vision after trans‐sylvian or temporobasal selective amygdalohippocampectomy: a prospective randomised trial. Acta Neurochirurgica 2016;158(9):1757‐65. - PubMed
    1. Vogt VL, Delev D, Grote A, Schramm J, Lehe M, Elger CE, et al. Neuropsychological outcome after subtemporal versus transsylvian approach for selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy: a randomised prospective clinical trial. Journal of Neurology, Neurosurgery & Psychiatry 2018;89(10):1057‐63. [DOI: 10.1136/jnnp-2017-316311; PUBMED: 29273691] - DOI - PubMed
Walz 2003 {published data only}
    1. Walz R, Castro RM, Velasco TR, Alexandre V Jr, Lopes MH, Leite JP, et al. Surgical outcome in mesial temporal sclerosis correlates with prion protein gene variant. Neurology 2003;61(9):1204‐10. - PubMed
Weinand 1992 {published data only}
    1. Weinand ME, Wyler AR, Richey ET, Phillips BB, Somes GW. Long‐term ictal monitoring with subdural strip electrodes: prognostic factors for selecting temporal lobectomy candidates. Journal of Neurosurgery 1992;77:20‐8. - PubMed
Wellmer 2012 {published data only}
    1. Wellmer J, Groeben F, Klarmann U, Weber C, Elger C, Urbach H, et al. Risks and benefits of invasive epilepsy surgery workup with implanted subdural and depth electrodes. Epilepsia 2012;53(8):1322‐32. - PubMed
Widdess‐Walsh 2007 {published data only}
    1. Widdess‐Walsh P, Jeha L, Nair D, Kotagal P, Bingaman W, Najm I. Subdural electrode analysis in focal cortical dysplasia: predictors of surgical outcome. Neurology 2007;69(7):660‐7. - PubMed
Wiebe 2001 {published data only}
    1. Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal‐lobe epilepsy. New England Journal of Medicine 2001;345(5):311‐8. - PubMed
Wieshmann 2008 {published data only}
    1. Wieshmann UC, Larkin D, Varma T, Eldridge P. Predictors of outcome after temporal lobectomy for refractory temporal lobe epilepsy. Acta Neurologica Scandinavica 2008;118(5):306‐12. - PubMed
Wray 2012 {published data only}
    1. Wray CD, McDaniel SS, Saneto RP, Novotny EJ Jr, Ojemann JG. Is postresective intraoperative electrocorticography predictive of seizure outcomes in children?. Journal of Neurosurgery. Pediatrics 2012;9(5):1546‐51. - PubMed
Wyler 1995 {published data only}
    1. Wyler AR, Hermann BP, Somes G. Extent of medial temporal resection on outcome from anterior temporal lobectomy: a randomized prospective study. Neurosurgery 1995;37:982‐90. - PubMed
Wyllie 1998 {published data only}
    1. Wyllie E, Comair YG, Kotagal P, Bulacio J, Bingaman W, Ruggirei P. Seizure outcome after epilepsy surgery in children and adolescents. Annals of Neurology 1998;44:740‐8. - PubMed
Yang 2011 {published data only}
    1. Yang XL, Lu QC, Xu JW, Wang GS, Liu Q. Predictors of outcome in the surgical treatment for epilepsy. Chinese Medical Journal 2011;124(24):4166‐71. - PubMed
Yeon 2009 {published data only}
    1. Yeon JY, Kim JS, Choi SJ, Seo DW, Hong SB, Hong SC. Supratentorial cavernous angiomas presenting with seizures: surgical outcomes in 60 consecutive patients. Seizure 2009;18(1):14‐20. - PubMed
Yu 2009 {published data only}
    1. Yu T, Wang Y, Zhang G, Cai L, Du W, Li Y. Posterior cortex epilepsy: diagnostic considerations and surgical outcome. Seizure 2009;18(4):288‐92. - PubMed
Yu 2012a {published data only}
    1. Yu T, Zhang G, Kohrman MH, Wang Y, Cai L, Shu W, et al. A retrospective study comparing preoperative evaluations and postoperative outcomes in paediatric and adult patients undergoing surgical resection for refractory epilepsy. Seizure 2012;21(6):444‐9. - PubMed
Yu 2012b {published data only}
    1. Yu T, Zhang G, Kohrman MH, Wang Y, Cai L, Shu W, et al. A retrospective study comparing preoperative evaluations and postoperative outcomes in paediatric and adult patients undergoing surgical resection for refractory epilepsy. Seizure 2012;21(6):444‐9. - PubMed
Zangaladze 2008 {published data only}
    1. Zangaladze A, Nei M, Liporace JD, Sperling MR. Characteristics and clinical significance of subclinical seizures. Epilepsia 2008;49(12):2016‐21. - PubMed
Zentner 1995 {published data only}
    1. Zentner J, Hufnagel A, Wolf HK, Ostertun B, Behrens E, Campos MG, et al. Surgical treatment of temporal lobe epilepsy: clinical, radiological and histopathological findings in 178 patients. Journal of Neurology, Neurosurgery and Psychiatry 1995;58:666‐73. - PMC - PubMed
Zentner 1996 {published data only}
    1. Zentner J, Hufnagel A, Ostertun B, Wolf HK, Behrens E, Campos MG, et al. Surgical treatment of extratemporal epilepsy: clinical, radiologic and histopathologic findings in 60 patients. Epilepsia 1996;37:1072‐80. - PubMed

References to studies excluded from this review

Acar 2008 {published data only}
    1. Acar G, Acar F, Miller, J, Spencer DC, Burchiel KJ. Seizure outcome following transcortical selective amygdalohippocampectomy in mesial temporal lobe epilepsy. Stereotactic & Functional Neurosurgery 2008;86(5):314‐9. - PubMed
Alemany‐Rosales 2011 {published data only}
    1. Alemany‐Rosales B, Prieto‐Montalvo J. Refractory temporal epilepsy. An analysis of 33 cases submitted to surgery [Epilepsia temporal farmacorresistante. Analisis de 33 casos intervenidos quirurgicamente]. Revista de Neurologia 2011;52(10):581‐9. - PubMed
Alpherts 2008 {published data only}
    1. Alpherts WC, Vermeulen J, Rijen PC, Lopes da Silva FH, Veelen WM, on behalf of the Dutch Collaborative Epilepsy Surgery Program. Verbal memory decline after temporal epilepsy surgery? A 6‐year multiple assessments follow‐up study. Neurology 2006;67(4):626‐31. - PubMed
Andersson‐Roswall 2010 {published data only}
    1. Andersson‐Roswall L, Engman E, Samuelsson H, Malmgren K. Cognitive outcome 10 years after temporal lobe surgery. Neurology 2011;74:1977‐85. - PubMed
Asadi‐Pooya 2008 {published data only}
    1. Asadi‐Pooya AA, Nei M, Sharan AD, Mintzer S, Zangaladze A, Evans JG, et al. Antiepileptic drugs and relapse after epilepsy surgery. Epileptic Disorders 2008;10(3):193‐8. - PubMed
Bauer 2007 {published data only}
    1. Bauer R, Dobesberger J, Unterhofer C, Unterberger I, Walser G, Bauer G, et al. Outcome of adult patients with temporal lobe tumours and medically refractory focal epilepsy. Journal of Neurosurgery 2011;7(2):179‐88. - PubMed
Baxendale 2005 {published data only}
    1. Baxendale S, Thompson P. Defining meaningful postoperative change in epilepsy surgery patients: measuring the unmeasurable?. Epilepsy & Behavior 2005;6(2):202‐11. - PubMed
Bell 2010 {published data only}
    1. Bell GS, Sinha S, Tisi J, Stephani C, Scott CA, Harkness WF, et al. Premature mortality in refractory partial epilepsy: does surgical treatment make a difference?. Journal of Neurology, Neurosurgery & Psychiatry 2010;81(7):716‐8. - PubMed
Binder 2009 {published data only}
    1. Binder DK, Lehe M, Kral T, Bien CG, Urbach H, Schramm J, et al. Surgical treatment of occipital lobe epilepsy. Journal of Neurosurgery 2008;109(1):57‐69. - PubMed
Bindu 2018 {published data only}
    1. Bindu B, Bindra A, Kaushal A, Prabhakar H, Chaturvedi A. Neuroprotective role of dexmedetomidine in epilepsy surgery: a preliminary study. Journal of neurosurgical anesthesiology Conference: 2017 annual scientific meeting of the neuro anaesthetic and critical care society of great britain and ireland. United Kingdom, 2018; Vol. 30(1):100.
Boesebeck 2002 {published data only}
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Boshuisen 2012 {published data only}
    1. Boshuisen K, Arzimanoglou A, Cross JH, Uiterwaal CS, Polster T, Nieuwenhuizen O, et al. TimeToStop study group. Timing of antiepileptic drug withdrawal and long‐term seizure outcome after paediatric epilepsy surgery (TimeToStop): a retrospective observational study. Lancet Neurology 2012;11(9):784‐91. - PubMed
Bourgeois 2007 {published data only}
    1. Bourgeois M, Crimmins DW, Oliveira RS, Arzimanoglou A, Garnett M, Roujeau T, et al. Surgical treatment of epilepsy in Sturge‐Weber syndrome in children. Journal of Neurosurgery 2007;106(1 Suppl):20‐8. - PubMed
Buckingham 2010 {published data only}
    1. Buckingham SE, Chervoneva I, Sharan A, Zangaladze A, Mintzer S, Skidmore C, et al. Latency to first seizure after temporal lobectomy predicts long‐term outcome. Epilepsia 2010;51(10):1987‐93. - PubMed
Busch 2011 {published data only}
    1. Busch RM, Dulay MF, Kim KH, Chapin JS, Jehi L, Kalman CC, et al. Pre‐surgical mood predicts memory decline after anterior temporal lobe resection for epilepsy. Archives of Clinical Neuropsychology 2011;26(8):739‐45. - PubMed
Caicoya 2007 {published data only}
    1. Caicoya AG, Macarron J, Albisua J, Serratosa JM. Tailored resections in occipital lobe epilepsy surgery guided by monitoring with subdural electrodes: characteristics and outcome. Epilepsy Research 2007;77(1):1‐10. - PubMed
Carne 2004 {published data only}
    1. Carne RP, O'Brien TJ, Kilpatrick CJ, MacGregor LR, Hicks RJ, Murphy MA, et al. MRI‐negative PET‐positive temporal lobe epilepsy: a distinct surgically remediable syndrome. Brain 2004;127(10):2276‐85. - PubMed
Cascino 1996 {published data only}
    1. Cascino GD, Trenerry MR, So EL, Sharbrough FW, Shin C, Lagerlund TD, et al. Routine EEG and temporal lobe epilepsy: relation to long‐term EEG monitoring, quantitative MRI, and operative outcome. Epilepsia 1995;37:651‐6. - PubMed
Chang 2007 {published data only}
    1. Chang EF, Wang DD, Barkovich AJ, Tihan T, Auguste KI, Sullivan JE, et al. Predictors of seizure freedom after surgery for malformations of cortical development. Annals of Neurology 2011;70:151‐62. - PubMed
Choi 2004b {published data only}
    1. Choi YL, Park SH, Chung CK, Suh YL, Chi JG. Cortical laminar disorganization is correlated with severity of the cortical dysplasia and surgical outcome ‐ experience with 150 cases. Epilepsy Research 2004;62(2‐3):171‐8. - PubMed
Cohen‐Gadol 2003 {published data only}
    1. Cohen‐Gadol AA, Wilhelmi BG, Collignon F, White JB, Britton JW, Cambier DM, et al. Long‐term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis. Journal of Neurosurgery 2006;104(4):513‐24. - PubMed
Colonnelli 2012 {published data only}
    1. Colonnelli MC, Cross JH, Davies S, D'Argenzio L, Scott RC, Pickles A, et al. Psychopathology in children before and after surgery for extratemporal lobe epilepsy. Developmental Medicine & Child Neurology 2012;54(6):521‐6. - PubMed
Coutin‐Churchman 2012 {published data only}
    1. Coutin‐Churchman PE, Wu JY, Chen LL, Shattuck K, Dewar S, Nuwer MR. Quantification and localization of EEG interictal spike activity in patients with surgically removed epileptogenic foci. Clinical Neurophysiology 2012;123(3):471‐85. - PubMed
CTRI/2018/07/015007 {published data only}
    1. CTRI/2018/07/015007. Are Intracranial electrodes mandatory to confirm the abnormal area in subtle Magnetic resonance positive drug resistant Epilepsy?‐ A Randomized controlled trial. Clinical Trials Registry India 2018.
Cukiert 2009 {published data only}
    1. Cukiert A, Burattini JA, Mariani PR, Cukiert CM, Argentoni‐Baldochi M, Baise‐Zung C, et al. Outcome after extended callosal section in patients with primary idiopathic generalized epilepsy. Epilepsia 2009;50(6):1377‐80. - PubMed
D'Angelo 2006 {published data only}
    1. D'Angelo VA, Bonis C, Amoroso R, Cali A, D'Agruma L, Guarnieri V, et al. Supratentorial cerebral cavernous malformations: clinical, surgical, and genetic involvement. Neurosurgical Focus 2006;21(1):e9; 1‐7. - PubMed
D'Argenzio 2011 {published data only}
    1. D'Argenzio L, Colonnelli MC, Harrison S, Jacques TS, Harkness W, Vargha‐Khadem F, et al. Cognitive outcome after extratemporal epilepsy surgery in childhood. Epilepsia 2011;52(11):1966‐72. - PubMed
da Costa‐Neves 2012 {published data only}
    1. Costa Neves RS, Jardim AP, Caboclo LO, Lancellotti C, Marinho TF, Hamad AP, et al. Granule cell dispersion is not a predictor of surgical outcome in temporal lobe epilepsy with mesial temporal sclerosis. Clinical Neuropathology 2013;32(1):24‐30. - PubMed
Danielsson 2009 {published data only}
    1. Danielsson S, Viggedal G, Steffenburg S, Rydenhag B, Gillberg C, Olsson I. Psychopathology, psychosocial functioning, and IQ before and after epilepsy surgery in children with drug‐resistant epilepsy. Epilepsy & Behavior 2009;14(2):330‐7. - PubMed
Datta 2009 {published data only}
    1. Datta A, Sinclair DB, Wheatley M, Jurasek L, Snyder T, Quigley D, et al. Selective amygdalohippocampectomy: surgical outcome in children versus adults. Canadian Journal of Neurological Sciences 2009;36(2):187‐91. - PubMed
Dulay 2006 {published data only}
    1. Dulay MF, York MK, Soety EM, Hamilton WJ, Mizrahi EM, Goldsmith IL, et al. Memory, emotional and vocational impairments before and after anterior temporal lobectomy for complex partial seizures. Epilepsia 2006;47(11):1922‐30. - PubMed
Dulay 2009 {published data only}
    1. Dulay MF, Levin HS, York MK, Li X, Mizrahi EM, Goldsmith I, et al. Changes in individual and group spatial and verbal learning characteristics after anterior temporal lobectomy. Epilepsia 2009;50(6):1385‐95. - PubMed
Elsharkawy 2008b {published data only}
    1. Elsharkawy AE, Alabbasi AH, Pannek H, Schulz R, Hoppe M, Pahs G, et al. Outcome of frontal lobe epilepsy surgery in adults. Epilepsy Research 2008;81:97‐106. - PubMed
Elsharkawy 2009b {published data only}
    1. Elsharkawy AE, El‐Ghandour NM, Oppel F, Pannek H, Schulz R, Hoppe M, et al. Long‐term outcome of lesional posterior cortical epilepsy surgery in adults. Journal of Neurology, Neurosurgery & Psychiatry 2009;80(7):773‐80. - PubMed
Elsharkawy 2011b {published data only}
    1. Elsharkawy AE, Pietilä TA, Alabbasi AH, Pannek H, Ebner A. Long term outcome in patients not initially seizure free after resective epilepsy surgery. Seizure 2011;20(5):419‐24. - PubMed
Engel Jr 2012 {published data only}
    1. Engel Jr J, McDermott M, Wiebe S, Langfitt J, Stern J, Dewar S, et al. Early surgical therapy for drug‐resistant temporal lobe epilepsy. JAMA 2012;307(9):922‐30. - PMC - PubMed
Fauser 2008 {published data only}
    1. Fauser S, Bast T, Altenmuller DM, Schulte‐Monting J, Strobl K, Steinhoff BJ, et al. Factors influencing surgical outcome in patients with focal cortical dysplasia. Journal of Neurology, Neurosurgery & Psychiatry 2008;79(1):103‐5. - PubMed
Ferrari‐Marinho 2012 {published data only}
    1. Ferrari‐Marinho T, Caboclo LO, Marinho MM, Centeno RS, Neves RS, Santana MT, et al. Auras in temporal lobe epilepsy with hippocampal sclerosis: relation to seizure focus laterality and post surgical outcome. Epilepsy & Behavior 2012;24(1):120‐5. - PubMed
Ferroli 2006 {published data only}
    1. Ferroli P, Casazza M, Marras C Mendola C, Franzini A, Broggi G. Cerebral cavernomas and seizures: a retrospective study on 163 patients who underwent pure lesionectomy. Neurological Sciences 2006;26(6):390‐4. - PubMed
Freitag 2005 {published data only}
    1. Freitag H, Tuxhorn I. Cognitive function in preschool children after epilepsy surgery: rationale for early intervention. Epilepsia 2005;46(4):561‐7. - PubMed
Ghacibeh 2009 {published data only}
    1. Ghacibeh GA, Smith JD, Roper SN, Gilmore R, Eisenschenk S. Seizure recurrence following epilepsy surgery: is post‐operative EEG helpful?. Seizure 2009;18(3):193‐6. - PubMed
Griffin 2007 {published data only}
    1. Griffin S, Tranel D. Age of seizure onset, functional reorganization, and neuropsychological outcome in temporal lobectomy. Journal of Clinical & Experimental Neuropsychology 2007;29(1):13‐24. - PMC - PubMed
Grunert 2003 {published data only}
    1. Grunert P, Charalampaki K, Kassem M, Boecher‐Schwarz H, Filippi R, Grunert P Jr. Frame‐based and frameless stereotaxy in the localization of cavernous angiomas. Neurosurgical Review 2003;26(1):53‐61. - PubMed
Haegelen 2013 {published data only}
    1. Haegelen C, Perucca P, Châtillon CE, Andrade‐Valença L, Zelmann R, Jacobs J, et al. High‐frequency oscillations, extent of surgical resection, and surgical outcome in drug‐resistant focal epilepsy. Epilepsia 2013;54(5):848‐57. - PMC - PubMed
Harvey 2008 {published data only}
    1. Harvey DJ, Naugle RI, Magleby J, Chapin JS, Najm IM, Bingaman W, et al. Relationship between presurgical memory performance on the Wechsler Memory Scale‐III and memory change following temporal resection for treatment of intractable epilepsy. Epilepsy & Behavior 2008;13(2):372‐5. - PubMed
Hellwig 2012 {published data only}
    1. Hellwig S, Mamalis P, Feige B, Schulze‐Bonhage A, Elst LT. Psychiatric comorbidity in patients with pharmacoresistant focal epilepsy and psychiatric outcome after epilepsy surgery. Epilepsy & Behavior 2012;23(2):272‐9. - PubMed
Helmstaedter 2004 {published data only}
    1. Helmstaedter C, Roost D, Clusmann H, Urbach H, Elger CE, Schramm J. Collateral brain damage, a potential source of cognitive impairment after selective surgery for control of mesial temporal lobe epilepsy. Journal of Neurology, Neurosurgery & Psychiatry 2004;75(2):323‐6. - PMC - PubMed
Helmstaedter 2011 {published data only}
    1. Helmstaedter C, Roeske S, Kaaden S, Elger C, Schramm J. Hippocampal resection length and memory outcome in selective epilepsy surgery. Journal of Neurology, Neurosurgery and Psychiatry 2011;82:1375‐81. - PubMed
Hervas‐Navidad 2002 {published data only}
    1. Hervas‐Navidad R, Altuzarra‐Corral A, Lucena‐Martin JA, Castaneda‐Guerrero M, Vela‐Yebra R, Sanchez‐A lvarez JC. Defects in the visual field in resective surgery for temporal lobe epilepsy [Defectos del campo visual en la cirurgia resectiva de la epilpesia del lobulo temporal]. Revista de Neurologia 2002;34(11):1025‐30. - PubMed
Hildebrandt 2005 {published data only}
    1. Hildebrandt M, Schulz R, Hoppe M, May T, Ebner A. Postoperative routine EEG correlates with long‐term seizure outcome after epilepsy surgery. Seizure 2005;14(7):446‐51. - PubMed
Hu 2012 {published data only}
    1. Hu WH, Ge M, Zhang K, Meng FG, Zhang JG. Seizure outcome with surgical management of epileptogenic ganglioglioma: a study of 55 patients. Acta Neurochirurgica 2012;154(5):855‐61. - PubMed
Jehi 2010 {published data only}
    1. Jehi LE, Silveira DC, Bingaman W, Najm I. Temporal lobe epilepsy surgery failures: predictors of seizure recurrence, yield of reevaluation, and outcome following reoperation. Journal of Neurosurgery 2010;116(6):1186‐94. - PubMed
Junna 2013 {published data only}
    1. Junna MR, Buechler R, Cohen‐Gadol AA, Mandrekar J, Christianson T, Marsh WR, et al. Prognostic importance of risk factors for temporal lobe epilepsy in patients undergoing surgical treatment. Mayo Clinic Proceedings 2013;88(5):332‐6. - PubMed
Kuzniecky 1996 {published data only}
    1. Kuzniecky RI, Burgard S, Bilir E, Morawetz R, Gilliam F, Faught E, et al. Qualitative MRI segmentation in mesial temporal sclerosis: clinical correlations. Epilepsia 1996;37:433‐9. - PubMed
Lach 2010 {published data only}
    1. Lach LM, Elliott I, Giecko T, Olds J, Snyder T, McCleary L, et al. Patient‐reported outcome of pediatric epilepsy surgery: social inclusion or exclusion as young adults?. Epilepsia 2010;51(10):2089‐97. - PubMed
Lachhwani 2003 {published data only}
    1. Lachhwani R, Luders H. In refractory temporal lobe epilepsy, consider surgery sooner. Cleveland Clinic Journal of Medicine 2003;70(7):649‐53. - PubMed
Lee 2010 {published data only}
    1. Lee YJ, Kang HC, Lee JS, Kim SH, Kim DS, Shim KW, et al. Resective pediatric epilepsy surgery in Lennox‐Gastaut syndrome. Pediatrics 2010;125(1):e58‐66. - PubMed
Limbrick 2009 {published data only}
    1. Limbrick DD, Narayan P, Powers AK, Ojemann JG, Park TS, Bertrand M, et al. Hemispherotomy: efficacy and analysis of seizure recurrence. Journal of Neurosurgery. Pediatrics 2009;4(4):323‐32. - PubMed
Lodenkemper 2007 {published data only}
    1. Loddenkemper T, Holland KD, Stanford LD, Kotagal P, Bingaman W, Wyllie E. Developmental outcome after epilepsy surgery in infancy. Pediatrics 2007;119(5):930‐5. - PubMed
Lutz 2004 {published data only}
    1. Lutz MT, Clusmann H, Elger CE, Schramm J, Helmstaedter C. Neuropsychological outcome after selective amygdalohippocampectomy with transsylvian versus transcortical approach: a randomized prospective clinical trial of surgery for temporal lobe epilepsy. Epilepsia 2004;45(7):809‐16. - PubMed
Malla 1998 {published data only}
    1. Malla B, O’Brien TJ, Cascino GD, So EL, Radhakrishnan K, Silbert P, et al. Acute postoperative seizures following anterior temporal lobectomy for intractable partial epilepsy. Journal of Neurosurgery 1998;89:177‐82. - PubMed
McClelland 2007 {published data only}
    1. McClelland S 3rd, Curran CC, Davey CS, Okuyemi KS. Intractable pediatric temporal lobe epilepsy in the United States: examination of race, age, sex, and insurance status as factors predicting receipt of resective treatment. Journal of Neurosurgery 2007;107(6 Suppl):469‐73. - PubMed
McClelland 2011 {published data only}
    1. McClelland S 3rd, Guo H, Okuyemi KS. Population‐based analysis of morbidity and mortality following surgery for intractable temporal lobe epilepsy in the United States. Archives of Neurology 2011;68(6):725‐9. - PubMed
Mikati 2004 {published data only}
    1. Mikati MA, Comair Y, Ismail R, Faour R, Rahi AC. Effects of epilepsy surgery on quality of life: a controlled study in a Middle Eastern population. Epilepsy & Behavior 2004;5(1):72‐80. - PubMed
Mohammed 2012 {published data only}
    1. Mohammed HS, Kaufman CB, Limbrick DD, Steger‐May K, Grubb RL Jr, Rothman SM, et al. Impact of epilepsy surgery on seizure control and quality of life: a 26‐year follow‐up study. Epilepsia 2012;53(4):712‐20. - PubMed
Moien‐Afshari 2009 {published data only}
    1. Moien‐Afshari F, Griebel R, Sadanand V, Vrbancic M, Hernandez‐Ronquillo L, Lowry N, et al. Safety and yield of early cessation of AEDs in video‐EEG telemetry and outcomes. Canadian Journal of Neurological Sciences 2009;36(5):587‐92. - PubMed
NCT03643016 {published data only}
    1. NCT03643016. Improving EPilepsy Surgery Management and progNOsis Using Virtual Epileptic Patient Software (VEP). ClinicalTrials.gov 2018.
NCT03790280 {published data only}
    1. NCT03790280. High Frequency Oscillation in Pediatric Epilepsy Surgery. ClinicalTrials.gov 2018.
Negishi 2011 {published data only}
    1. Negishi M, Martuzzi R, Novotny EJ, Spencer DD, Constable RT. Functional MRI connectivity as a predictor of the surgical outcome of epilepsy. Epilepsia 2011;52(9):1733‐40. - PMC - PubMed
Nikase 2007 {published data only}
    1. Nakase H, Tamura K, Kim YJ, Hirabayashi H, Sakaki T, Hoshida T. Long‐term follow‐up outcome after surgical treatment for lesional temporal lobe epilepsy. Neurological Research 2007;29(6):588‐93. - PubMed
Oertel 2004 {published data only}
    1. Oertel J, Gaab MR, Runge U, Schroeder HW, Wagner W, Piek J. Neuronavigation and complication rate in epilepsy surgery. Neurosurgical Review 2004;27(3):214‐7. - PubMed
Ogiwara 2010 {published data only}
    1. Ogiwara H, Nordli DR, DiPatri AJ, Alden TD, Bowman RM, Tomita T. Pediatric epileptogenic gangliogliomas: seizure outcome and surgical results. Journal of Neurosurgery. Pediatrics 2010;5(3):271‐6. - PubMed
Park 2010 {published data only}
    1. Park KI, Lee SK, Chu K, Jung KH, Bae EK, Kim JS, et al. Withdrawal of antiepileptic drugs after neocortical epilepsy surgery. Annals of Neurology 2010;67(2):230‐8. - PubMed
Placantonakis 2010 {published data only}
    1. Placantonakis D, Shariff S, Lafaille F, Labar D, Harden C, Hosain S, et al. Bilateral intracranial electrodes for lateralizing intractable epilepsy: efficacy, risk and outcome. Neurosurgery 2010;66:274‐83. - PubMed
Rocamora 2009 {published data only}
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Roth 2011 {published data only}
    1. Roth J, Olasunkanmi A, MacAllister WS, Weil E, Uy CC, Devinsky O, et al. Quality of life following epilepsy surgery for children with tuberous sclerosis complex. Epilepsy & Behavior 2011;20(3):561‐5. - PubMed
Sakuta 2005 {published data only}
    1. Sakuta R, Otsubo H, Nolan MA, Weiss SK, Hawkins C, Rutka JT, et al. Recurrent intractable seizures in children with cortical dysplasia adjacent to dysembryoplastic neuroepithelial tumor. Journal of Child Neurology 2005;20(4):377‐84. - PubMed
Schatlo 2015 {published data only}
    1. Schatlo B, Jagersberg M, Paass G, Faltermeier R, Streich J, Meyer B, et al. Cerebral blood flow reactivity in patients undergoing selective amygdalohippocampectomy for epilepsy of mesial temporal origin. A prospective randomized comparison of the trans‐Sylvian and the transcortical approach. Neurological Research 2015;37(12):1037‐46. - PubMed
Schwartz 2006 {published data only}
    1. Schwartz TH, Jeha L, Tanner A, Bingaman W, Sperling MR. Late seizures in patients initially seizure free after epilepsy surgery. Epilepsia 2006;47(3):567‐73. - PubMed
Smyth 2007 {published data only}
    1. Smyth MD, Limbrick DD Jr, Ojemann JG, Zempel J, Robinson S, O'Brien DF, et al. Outcome following surgery for temporal lobe epilepsy with hippocampal involvement in preadolescent children: emphasis on mesial temporal sclerosis. Journal of Neurosurgery 2007;106(3 Suppl):205‐10. - PubMed
Soeder 2009 {published data only}
    1. Soeder BM, Gleissner U, Urbach H, Clusmann H, Elger CE, Vincent A, et al. Causes, presentation and outcome of lesional adult onset mediotemporal lobe epilepsy. Journal of Neurology, Neurosurgery & Psychiatry 2009;80(8):894‐9. - PubMed
Stavem 2005 {published data only}
    1. Stavem K, Guldvog B. Long‐term survival after epilepsy surgery compared with matched epilepsy controls and the general population. Epilepsy Research 2005;63(1):67‐75. - PubMed
Stavem 2008 {published data only}
    1. Stavem K, Bjornaes H, Langmoen IA. Long‐term seizures and quality of life after epilepsy surgery compared with matched controls. Neurosurgery 2008;62(2):326‐34. - PubMed
Stefan 2004 {published data only}
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Stefan 2008 {published data only}
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