Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 6.
doi: 10.1002/epd2.70101. Online ahead of print.

Long-term outcomes of epilepsy surgery: A 25-year experience from a tertiary referral center

Marco Almeida  1   2 , Francisco Barros  1   2 , Inês Cunha  1   2 , Ana Brás  1   2 , Rute Teotónio  1   2 , Conceição Bento  1   2 , Francisco Sales  1   2
Affiliations

Long-term outcomes of epilepsy surgery: A 25-year experience from a tertiary referral center

Marco Almeida et al. Epileptic Disord. .

Abstract

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 one ASM. Temporal surgeries (χ2(1) = 8.444, p < 0.05), left-sided surgeries (χ2(1) = 6.436, p = 0.04), mesial sclerosis (χ2(1) = 50.870, p = 0.024), and the use of intraoperative ECOG (χ2(1) = 23.235, p < 0.001) 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 = 0.659).

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.

Keywords: ECOG; epilepsy; mesial sclerosis; refractory epilepsy.

PubMed Disclaimer

References

REFERENCES

    1. Kalilani L, Sun X, Pelgrims B, Noack‐Rink M, Villanueva V. The epidemiology of drug‐resistant epilepsy: a systematic review and meta‐analysis. Epilepsia. 2018;59(12):2179–2193.
    1. Sultana B, Panzini MA, Veilleux Carpentier A, Comtois J, Rioux B, Gore G, et al. Incidence and prevalence of drug‐resistant epilepsy: a systematic review and meta‐analysis. Neurology. 2021;96(17):805–817.
    1. Malmgren K, Edelvik A. Long‐term outcomes of surgical treatment for epilepsy in adults with regard to seizures, antiepileptic drug treatment and employment. Seizure. 2017;44:217–224.
    1. Braams O, Maher C, Jennekens‐Schinkel A, Braun K, van Nieuwenhuizen O, van Schooneveld M, et al. Social functioning of children after epilepsy surgery: a literature review. Epilepsy Behav. 2019;96:210–218.
    1. Téllez‐Zenteno JF, Dhar R, Wiebe S. Long‐term seizure outcomes following epilepsy surgery: a systematic review and meta‐analysis. Brain. 2005;128(Pt 5):1188–1198.

LinkOut - more resources