Abstract
Objective To describe long-term seizure remission and relapse patterns, psychiatric comorbidity, and socioeconomic outcomes following frontal lobe epilepsy surgery.
Methods We reviewed data on frontal lobe epilepsy procedures at the National Hospital for Neurology & Surgery, UK, between 1990 and 2020. This included the presurgical evaluation, operative details and annual postoperative seizure and psychiatric outcomes, prospectively recorded in an epilepsy surgery database. Outcome predictors were subjected to multivariable analysis, and rates of seizure freedom analysed using Kaplan-Meier methods. We used longitudinal assessment of the Index of Multiple Deprivation to assess change in socioeconomic status over time.
Results A total of 122 individuals with a median follow-up of seven years were included. Of these, 33 (27%) had complete seizure freedom following surgery, with a further 13 (11%) having only auras. Focal MRI abnormality, a focal lesion on histology (focal cortical dysplasia, cavernoma or dysembryoplastic neuronal epithelial tumour) and fewer anti-seizure medications at time of surgery were predictive of favourable outcome; 67% of those seizure-free for the first 12 months postoperatively never experienced seizure relapse. Thirty-one of 50 who had preoperative psychiatric pathology noticed improved psychiatric symptomatology by two years postoperatively. New psychiatric comorbidity was diagnosed in 15 (13%). Persistent motor complications occurred in 5% and dysphasia in 2%. No significant change in socioeconomic deciles of deprivation was observed after surgery.
Conclusion Favourable long-term seizure, psychiatric and socioeconomic outcomes can be seen following frontal lobe epilepsy surgery. This is a safe and effective treatment that should be offered to suitable individuals early.
