Analysis of incomplete remission cases in post-surgery patients with focal drug-resistant epilepsy

Background. Epilepsy surgery is mainly aimed at removing patient seizures. Despite the high efficiency of surgical treatment, a search for probable predictors of adverse outcomes and the analysis of the quality of life (QoL) in patients attempted to be surgically assisted provide only partial relief from disturbing paroxysms remain relevant.

Objective: To comprehensively assess disease parameters in post-surgery patients with focal drug-resistant epilepsy (DRE) with incomplete remission (Engel II–IV outcomes), and to identify QoL prognostic factors.

Material and methods. A single-center, retrospective, observational study assessing 67 patients with incomplete remission (Engel II–IV outcomes) operated for focal DRE was carried out. The following disease parameters identified as potentially possible QoL predictors after surgical treatment were analyzed: seizure frequency and severity post-surgery; dominance of the brain hemisphere underwent surgery; pre-surgery seizure type; neurological deficit post-surgery; epileptogenic substrate morphology; resection zone; extent of resection; disease duration.

Results. In patients with Engel II–IV surgery outcomes, a quite high level of positive subjective self-assessment condition (52,2%) was revealed, with number of seizures reduced by at least 50% in 59,7% cases. A statistically significant influence on the positive subjective QoL assessment based on criteria such as decreased frequency and strength of seizures after surgery (p<0,001) was found. Tailored resection of the epileptogenic zone led to aggravated seizure severity and frequency outcomes. Lobectomies and disconnection operations in 45,7% cases were accompanied by reduced number of seizures by at least 75%. Temporal lobe surgeries, compared with extratemporal resections, were more often correlated with QoL improvement.

Conclusion. In most cases, DRE surgical treatment leads to lower seizure rate and significantly improved QoL, even in the case of incomplete remission. Seizure frequency and severity post-surgery were the only parameters affecting postsurgical QoL in patients with incomplete remission.

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