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Understanding the Delay Before Epilepsy Surgery: Who Develops Intractable Focal Epilepsy and When?

Published online by Cambridge University Press:  07 November 2014

Anne T. Berg
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Abstract

Intractable temporal lobe epilepsy that is surgically treated in adulthood is a disorder whose onset frequently occurs during childhood and early adolescence. The average duration of epilepsy prior to surgery is on the order of 20 years. The long delay between onset and surgery has at least two components: time from onset to intractability and time from evidence of intractability to surgery. The first interval is prolonged >10 years especially if the onset is during childhood. This suggests a complex natural history that we have not fully appreciated as well as a potential window of opportunity for early secondary intervention. The second interval is also prolonged, especially if onset was during childhood. Reasons for this are not fully clear but may include a reluctance to consider surgery and perhaps difficulty deciding whether seizures are sufficiently intractable to warrant surgery especially after what may have been a relatively benign initial course. Factors involved in the second delay need to be better understood so that surgical interventions can be appropriately targeted early rather than late, thereby reducing serious social, psychological, and educational consequences associated with uncontrolled seizures.

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Type
Review Article
Information
CNS Spectrums , Volume 9 , Issue 2 , February 2004, pp. 136 - 144
Copyright
Copyright © Cambridge University Press 2004

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References

REEERENCES

1.Berg, AT, Shinnar, S, Levy, SR, Testa, FM. Newly-diagnosed epilepsy in children: presentation at diagnosis. Epilepsia. 1999;40:445–452.CrossRefGoogle ScholarPubMed
2.Jallon, P, Loiseau, P, Loiseau, J. Newly diagnosed unprovoked epileptic seizures: presentation at diagnosis in CAROLE study. Epilepsia. 2001;42:464–475.CrossRefGoogle ScholarPubMed
3.Groupe CAROLE (Coordination Active du Réseau Observatoire Longitudinal de l'Epilepsie). Délais évolutifs des syndromes épileptiques avant leur diagnostic: résultats descriptifs de l'enquête CAROLE. Rev Neurol. 2000;156:481–490.Google Scholar
4.Engel, J Jr. Update on surgical treatment of the epilepsies. In: Engel, J Jr, ed. Surgical Treatment of Epilepsies. New York, NY: Raven Press; 1987:32–48.Google Scholar
5.Salanova, V, Markand, ON, Worth, R. Clinical characteristics and predictive factors in 98 patients with complex partial seizures treated with temporal lobe resection. Arch Neurol. 1994;51:1009–1013.CrossRefGoogle Scholar
6.Arruda, F, Cendes, F, Andermann, F, et al.Mesial atrophy and outcome after amygdalohippocampectomy or temporal lobe removal. Ann Neurol. 1996;40:446–450.CrossRefGoogle ScholarPubMed
7.Cascino, GD, Trenerry, MR, So, EL, Sharbrough, FW, Shin, C, Lagerlund, TD, Zupanc, ML, Jack, CR Jr. Routine EEG and temporal lobe epilepsy: relation to long-term EEG monitoring, quantitative MRI, and operative outcome. Epilepsia. 1996;37:651–656.CrossRefGoogle ScholarPubMed
8.Wiebe, S, Blume, WT, Girvin, JP, Eliasziw, M. A randomized controlled trial of surgery for temporal-lobe epilepsy. N Eng J Med. 2001;345:311–318.CrossRefGoogle ScholarPubMed
9.Houghton, D, Sperling, M, Salmon, EA, O'Connor, M, Berg, AT. Preoperative predictors of postoperative seizure recurrence after anterior temporal lobectomy. Neurology. 2002;58(suppl 3):94.Google Scholar
10.Berg, AT, Langfitt, J, Shinnar, S, et al.How long does it take for partial epilepsy to become intractable? Neurology. 2003;60:186–190.CrossRefGoogle ScholarPubMed
11.Engel, J, Wiebe, S, French, J, et al.Practice parameter: temporal lobe and localized neocortical resections for epilepsy. Neurology 2003;60:538–547.CrossRefGoogle ScholarPubMed
12.Engel, J Jr. Update on surgical treatment of the epilepsies. Summary of the Second International Palm Desert Conference on the Surgical Treatment of the Epilepsies (1992). Neurology. 1993;43:1612–1617.CrossRefGoogle ScholarPubMed
13.French, JA, Williamson, PD, Thadani, VM, et al.Characteristics of medial temporal lobe epilepsy: I. results of history and physical examination. Ann Neurol. 1993;34:774–780.CrossRefGoogle ScholarPubMed
14.Annegers, JF, Hauser, WA, Elveback, LR. Remission of seizures and relapse in patients with epilepsy. Epilepsia. 1979;20:729–737.CrossRefGoogle ScholarPubMed
15.Mathern, G, Giza, CC, Yudovin, S, et al.Postoperative seizure control and antiepileptic drug use in pediatric epilepsy surgery patients: the UCLA experience, 1986–1997. Epilepsia. 1999;40:1740–1749.CrossRefGoogle Scholar
16.Vickrey, BG, Hays, RD, Rausch, R, et al.Outcomes in 248 patients who had diagnostic evaluations for epilepsy surgery. Lancet. 1995;346:1445–1450.CrossRefGoogle ScholarPubMed
17.Spencer, SS, Novotny, E, de Lanerolle, N, Lim, J. Mesial temporal sclerosis: electroclinical and pathological correlations and applications to limbic epilepsy in childhood. In: Avanzini, G, Beaumanoir, A, Mira, L, eds. Limbic Seizures in Children. London, England: J Libbey & Co.; 2001:41–54.Google Scholar
18.Berg, AT. Évolution des syndromes épileptiques au cours du temps [French]. Épilepsies. 2002;14:107–114.Google Scholar
19.Berg, AT, Testa, FM, Levy, SR, Shinnar, S. Neuroimaging in children with newly diagnosed epilepsy: a community-based study. Pediatrics. 2000;106:527–532.CrossRefGoogle ScholarPubMed
20.Dlugos, D, Sammel, M, Strom, B, Farrar, J. Response to first drug trial predicts outcome in childhood temporal lobe epilepsy. Neurology. 2001;57:2259–2264.CrossRefGoogle ScholarPubMed
21.Dlugos, D. The early identification of candidates for epilepsy surgery. Arch Neurol. 2001;58:1543–1546.CrossRefGoogle ScholarPubMed
22.Berg, AT, Shinnar, S, Levy, SR, Testa, FM, Smith-Rapaport, S, Beckerman, B. Defining early seizure outcomes in pediatric epilepsy: the good, the bad and the in-between. Epilepsy Res. 2001;43:75–84.CrossRefGoogle ScholarPubMed
23.Kwan, P, Brodie, MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;3:314–319.CrossRefGoogle Scholar
24.Engel, J Jr. The timing of surgical intervention for mesial temporal lobe epilepsy: a plan for a randomized clinical trial. Arch Neurol. 1999;56:1338–1341.CrossRefGoogle ScholarPubMed
25.Berg, AT, Shinnar, S, Levy, SR, Testa, F, Smith-Rapaport, S, Beckerman, B. Intractable epilepsy in children: a prospective study. Neurology. 2001;56:1445–1452.CrossRefGoogle ScholarPubMed
26.Arts, WF, Geerts, AT, Brouwer, OF, Boudewyn Peters, AC, Stroink, H, van Donselaar, CA. The early prognosis of epilepsy in childhood: the prediction of a poor outcome. The Dutch study of epilepsy in childhood. Epilepsia. 1999;40:726–734.CrossRefGoogle ScholarPubMed
27.Beghi, E, Tognoni, G. Prognosis of epilepsy in newly referred patients: a multicenter prospective study. Epilepsia. 1988;29:236–243.CrossRefGoogle ScholarPubMed
28.Cockerell, O, Johnson, A, Sander, J, Shorvon, S. Prognosis of epilepsy: a review and further analysis of the first nine years of the British National General Practice Study of Epilepsy, a prospective population-based study. Epilepsia. 1997;38:31–46.CrossRefGoogle ScholarPubMed
29.Dulac, O. Epileptic encephalopathy. Epilepsia 2001;42(suppl 3):23–26.CrossRefGoogle ScholarPubMed
30.Berg, AT, Shinnar, S, Levy, SR, Testa, FM. Childhood-onset epilepsy with and without preceding febrile seizures. Neurology. 1999;53:1742–1748.CrossRefGoogle ScholarPubMed