The University of Southampton
University of Southampton Institutional Repository

Premature mortality in refractory partial epilepsy: does surgical treatment make a difference?

Premature mortality in refractory partial epilepsy: does surgical treatment make a difference?
Premature mortality in refractory partial epilepsy: does surgical treatment make a difference?
Background: Epilepsy carries an increased risk of premature death. For some people with intractable focal epilepsy, surgery offers hope for a seizure-free life. The authors aimed to see whether epilepsy surgery influenced mortality in people with intractable epilepsy.

Methods: The authors audited survival status in two cohorts (those who had surgery and those who had presurgical assessment but did not have surgery).

Results: There were 40 known deaths in the non-surgical group (3365 person years of follow-up) and 19 in the surgical group (3905 person-years of follow-up). Non-operated patients were 2.4 times (95% CI 1.4 to 4.2) as likely to die as those who had surgery. They were 4.5 times (95% CI 1.9 to 10.9) as likely to die a probable epilepsy-related death. In the surgical group, those with ongoing seizures 1 year after surgery were 4.0 (95% CI 1.2 to 13.7) times as likely to die as those who were seizure-free or who had only simple partial seizures. Time-dependent Cox analysis showed that the yearly outcome group did not significantly affect mortality (HR 1.3, 95% CI 0.9 to 1.8).

Conclusion: Successful epilepsy surgery was associated with a reduced risk of premature mortality, compared with those with refractory focal epilepsy who did not have surgical treatment. To some extent, the reduced mortality is likely to be conferred by inducing freedom from seizures. It is not certain whether better survival is attributable only to surgery, as treatment decisions were not randomised, and there may be inherent differences between the groups.

1468-330X
716-718
Bell, G.S.
a1fb29dd-d92f-475a-92f7-01476fc0b615
Sinha, S.
8c214f61-b994-48ae-9f1f-535a46fd9c93
Tisi, J.
6de6642a-98ab-41d4-a0e4-56bfa5062802
Stephani, C.
b9d0cbda-d039-4e67-bf9d-4ad22a0ca8bd
Scott, C.A.
b319e8e2-765e-4cec-be80-705cfac5d0d3
Harkness, W.F.
5cbd0deb-16b8-45c7-8b83-83061548ca7f
McEvoy, A.W.
e17ad7da-cfd7-4617-8d03-17baaa3802fd
Peacock, J.L.
8362b3b1-458f-4152-936f-344ca1c7e0ba
Walker, M.C.
a2ab4f71-3cb1-434c-a179-9f187897efd0
Smith, S.J.
d86da701-77fa-4f0f-b016-3017ba94afa5
Dunacan, S.J.
5d6d38dc-466d-4cf5-b15e-c52ddb487185
Sander, J.W.
f98471a3-1631-4bc0-b7e4-cc592f1192d4
Bell, G.S.
a1fb29dd-d92f-475a-92f7-01476fc0b615
Sinha, S.
8c214f61-b994-48ae-9f1f-535a46fd9c93
Tisi, J.
6de6642a-98ab-41d4-a0e4-56bfa5062802
Stephani, C.
b9d0cbda-d039-4e67-bf9d-4ad22a0ca8bd
Scott, C.A.
b319e8e2-765e-4cec-be80-705cfac5d0d3
Harkness, W.F.
5cbd0deb-16b8-45c7-8b83-83061548ca7f
McEvoy, A.W.
e17ad7da-cfd7-4617-8d03-17baaa3802fd
Peacock, J.L.
8362b3b1-458f-4152-936f-344ca1c7e0ba
Walker, M.C.
a2ab4f71-3cb1-434c-a179-9f187897efd0
Smith, S.J.
d86da701-77fa-4f0f-b016-3017ba94afa5
Dunacan, S.J.
5d6d38dc-466d-4cf5-b15e-c52ddb487185
Sander, J.W.
f98471a3-1631-4bc0-b7e4-cc592f1192d4

Bell, G.S., Sinha, S., Tisi, J., Stephani, C., Scott, C.A., Harkness, W.F., McEvoy, A.W., Peacock, J.L., Walker, M.C., Smith, S.J., Dunacan, S.J. and Sander, J.W. (2010) Premature mortality in refractory partial epilepsy: does surgical treatment make a difference? Journal of Neurology, Neurosurgery, and Psychiatry, 81 (7), 716-718. (doi:10.1136/jnnp.2008.170837). (PMID:20478848)

Record type: Article

Abstract

Background: Epilepsy carries an increased risk of premature death. For some people with intractable focal epilepsy, surgery offers hope for a seizure-free life. The authors aimed to see whether epilepsy surgery influenced mortality in people with intractable epilepsy.

Methods: The authors audited survival status in two cohorts (those who had surgery and those who had presurgical assessment but did not have surgery).

Results: There were 40 known deaths in the non-surgical group (3365 person years of follow-up) and 19 in the surgical group (3905 person-years of follow-up). Non-operated patients were 2.4 times (95% CI 1.4 to 4.2) as likely to die as those who had surgery. They were 4.5 times (95% CI 1.9 to 10.9) as likely to die a probable epilepsy-related death. In the surgical group, those with ongoing seizures 1 year after surgery were 4.0 (95% CI 1.2 to 13.7) times as likely to die as those who were seizure-free or who had only simple partial seizures. Time-dependent Cox analysis showed that the yearly outcome group did not significantly affect mortality (HR 1.3, 95% CI 0.9 to 1.8).

Conclusion: Successful epilepsy surgery was associated with a reduced risk of premature mortality, compared with those with refractory focal epilepsy who did not have surgical treatment. To some extent, the reduced mortality is likely to be conferred by inducing freedom from seizures. It is not certain whether better survival is attributable only to surgery, as treatment decisions were not randomised, and there may be inherent differences between the groups.

Text
jnnp.2008.170837.full.pdf - Other
Download (147kB)

More information

e-pub ahead of print date: 16 May 2010
Published date: July 2010

Identifiers

Local EPrints ID: 156585
URI: http://eprints.soton.ac.uk/id/eprint/156585
ISSN: 1468-330X
PURE UUID: 4ce5d419-8ee8-459d-98ea-522025f2401c

Catalogue record

Date deposited: 01 Jun 2010 11:24
Last modified: 11 Nov 2019 21:19

Export record

Altmetrics

Contributors

Author: G.S. Bell
Author: S. Sinha
Author: J. Tisi
Author: C. Stephani
Author: C.A. Scott
Author: W.F. Harkness
Author: A.W. McEvoy
Author: J.L. Peacock
Author: M.C. Walker
Author: S.J. Smith
Author: S.J. Dunacan
Author: J.W. Sander

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×