Het Nederlandse epilepsiechirurgieprogramma: aanvalsreductie, operatieve complicaties en vermindering van medicatie bij 338 patiënten, 1973-1998

To determine the results of surgical treatment in patients with drug-resistant epilepsy, referred to the Dutch Epilepsy Surgery Program, who were treated in the University Medical Centre Utrecht, the Netherlands, in the period January 1973-December 1998.

Design

Retrospective descriptive.

Method

A total of 338 patients were operated on; 269 underwent temporal lobe resection, 41 extratemporal resection, 12 a functional hemispherectomy and 10 callosotomy. Six patients were treated with vagus nerve stimulation. For seven of the patients no follow-up data was available.

Results

After a minimum follow-up of 1 year class I or class II results (in accordance with the University of California in Los Angeles classification (UCLA) where class I = seizure-free and class II ≤ 3 seizures per year) were obtained in 91 of patients who underwent temporal lobe resections, 67 of patients who underwent extratemporal resections, 81 of patients who underwent functional hemispherectomy and 10 of patients who underwent anterior callosotomy. In five of these patients an improvement in their behaviour occurred. Of the 6 patients who underwent vagus nerve stimulation only 1 experienced a beneficial seizure reduction (UCLA class III). Transient physical complications occurred in 4 of the patients treated and permanent damage in 1. Postoperative psychiatric complications occurred almost exclusively following temporal resections; in 11 of which 7 de novo. After 4 postoperative years this had decreased to 5. In a group of 143 patients who were seizure-free for 2 or more years, post-surgery medication was tapered in 75 cases, stopped in 33 cases and remained unchanged in 35 cases. The relapse rate following a tapering or stopping of the medication was 30 and with unchanged medication 17. Although the majority of patients were once again seizure-free upon restarting the medication, a significant number continued to experience seizures.

Conclusion

For a number of carefully selected epilepsy patients with intractable seizures, surgery is a successful treatment with few serious complications.