Reduced long-term mortality after successful resective epilepsy surgery : A population-based study
(2023) In Journal of Neurology, Neurosurgery and Psychiatry- Abstract
Background: We investigated all-cause and epilepsy-related mortality in patients operated with resective epilepsy surgery and in non-operated patients with drug-resistant epilepsy. Our hypothesis was that patients who proceed to surgery have lower mortality over time compared with non-operated patients. Method: Data from 1329 adults and children from the Swedish National Epilepsy Surgery Register and 666 patients with drug-resistant epilepsy who had undergone presurgical work-up but not been operated were analysed. The operated patients had follow-ups between 2 and 20 years. We used the Swedish Cause of Death Register to identify deaths. Autopsy reports were collected for patients with suspected sudden unexpected death in epilepsy... (More)
Background: We investigated all-cause and epilepsy-related mortality in patients operated with resective epilepsy surgery and in non-operated patients with drug-resistant epilepsy. Our hypothesis was that patients who proceed to surgery have lower mortality over time compared with non-operated patients. Method: Data from 1329 adults and children from the Swedish National Epilepsy Surgery Register and 666 patients with drug-resistant epilepsy who had undergone presurgical work-up but not been operated were analysed. The operated patients had follow-ups between 2 and 20 years. We used the Swedish Cause of Death Register to identify deaths. Autopsy reports were collected for patients with suspected sudden unexpected death in epilepsy (SUDEP). Kaplan-Meier and Cox regression analyses were performed to identify predictors for mortality and SUDEP. Results: SUDEP accounted for 30% of all deaths. Surgery was associated with lower all-cause mortality (HR 0.7, 95% CI 0.5 to 0.9), also when adjusted for age, sex and tonic-clonic seizures at inclusion. The benefit of surgery seemed to persist and possibly even increase after 15 years of follow-up. Risk factors of mortality for operated patients were persisting seizures and living alone. Of the operated patients, 37% had seizures, and these had a higher risk of mortality (HR 2.1, 95% CI 1.4 to 3.0) and SUDEP (HR 3.5, 95% CI 1.7 to 7.3) compared with patients with seizure freedom at last follow-up. Conclusions: In this large population-based epilepsy surgery cohort, operated patients had a lower all-cause mortality compared with non-operated patients with drug-resistant epilepsy. Seizure freedom was the most important beneficial factor for both all-cause mortality and SUDEP among operated patients.
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- author
- Granthon, Cecilia ; Tranberg, Anna Edelvik ; Malmgren, Kristina ; Strandberg, Maria Compagno LU ; Kumlien, Eva and Redfors, Petra
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- EPILEPSY, EPILEPSY, SURGERY, SUDDEN DEATH
- in
- Journal of Neurology, Neurosurgery and Psychiatry
- article number
- jnnp-2023-331417
- publisher
- BMJ Publishing Group
- external identifiers
-
- pmid:37734927
- scopus:85173522635
- ISSN
- 0022-3050
- DOI
- 10.1136/jnnp-2023-331417
- language
- English
- LU publication?
- yes
- id
- 5d4d4d35-42cb-40e9-86b7-217f45082abc
- date added to LUP
- 2023-12-20 08:49:52
- date last changed
- 2024-04-18 18:32:08
@article{5d4d4d35-42cb-40e9-86b7-217f45082abc,
abstract = {{<p>Background: We investigated all-cause and epilepsy-related mortality in patients operated with resective epilepsy surgery and in non-operated patients with drug-resistant epilepsy. Our hypothesis was that patients who proceed to surgery have lower mortality over time compared with non-operated patients. Method: Data from 1329 adults and children from the Swedish National Epilepsy Surgery Register and 666 patients with drug-resistant epilepsy who had undergone presurgical work-up but not been operated were analysed. The operated patients had follow-ups between 2 and 20 years. We used the Swedish Cause of Death Register to identify deaths. Autopsy reports were collected for patients with suspected sudden unexpected death in epilepsy (SUDEP). Kaplan-Meier and Cox regression analyses were performed to identify predictors for mortality and SUDEP. Results: SUDEP accounted for 30% of all deaths. Surgery was associated with lower all-cause mortality (HR 0.7, 95% CI 0.5 to 0.9), also when adjusted for age, sex and tonic-clonic seizures at inclusion. The benefit of surgery seemed to persist and possibly even increase after 15 years of follow-up. Risk factors of mortality for operated patients were persisting seizures and living alone. Of the operated patients, 37% had seizures, and these had a higher risk of mortality (HR 2.1, 95% CI 1.4 to 3.0) and SUDEP (HR 3.5, 95% CI 1.7 to 7.3) compared with patients with seizure freedom at last follow-up. Conclusions: In this large population-based epilepsy surgery cohort, operated patients had a lower all-cause mortality compared with non-operated patients with drug-resistant epilepsy. Seizure freedom was the most important beneficial factor for both all-cause mortality and SUDEP among operated patients.</p>}},
author = {{Granthon, Cecilia and Tranberg, Anna Edelvik and Malmgren, Kristina and Strandberg, Maria Compagno and Kumlien, Eva and Redfors, Petra}},
issn = {{0022-3050}},
keywords = {{EPILEPSY; EPILEPSY, SURGERY; SUDDEN DEATH}},
language = {{eng}},
publisher = {{BMJ Publishing Group}},
series = {{Journal of Neurology, Neurosurgery and Psychiatry}},
title = {{Reduced long-term mortality after successful resective epilepsy surgery : A population-based study}},
url = {{http://dx.doi.org/10.1136/jnnp-2023-331417}},
doi = {{10.1136/jnnp-2023-331417}},
year = {{2023}},
}