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Long-term Outcome of Nonsurgical Candidates with Medically Refractory Localization-related Epilepsy

dc.contributor.authorSelwa, Linda M.en_US
dc.contributor.authorSchmidt, Shelley L.en_US
dc.contributor.authorMalow, Beth A.en_US
dc.contributor.authorBeydoun, Ahmad A.en_US
dc.date.accessioned2010-04-01T15:13:53Z
dc.date.available2010-04-01T15:13:53Z
dc.date.issued2003-12en_US
dc.identifier.citationSelwa, Linda M.; Schmidt, Shelley L.; Malow, Beth A.; Beydoun, Ahmad (2003). "Long-term Outcome of Nonsurgical Candidates with Medically Refractory Localization-related Epilepsy." Epilepsia 44(12): 1568-1572. <http://hdl.handle.net/2027.42/65701>en_US
dc.identifier.issn0013-9580en_US
dc.identifier.issn1528-1167en_US
dc.identifier.urihttps://hdl.handle.net/2027.42/65701
dc.identifier.urihttp://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=14636329&dopt=citationen_US
dc.description.abstractPurpose: Epilepsy surgery can result in complete seizure remission rates of upto 80% in patients with mesial temporal sclerosis and unilateral seizures. The seizure-free rate after surgery for patients with extratemporal nonlesional epilepsy has ranged between 30% and 40%. Some patients with medically refractory localization-related epilepsy cannot be offered surgical resection because of inadequate localization of the epileptogenic zone, documentation of bilateral ictal onsets, or functionally important areas of cortex that prohibit resection. The short-term rate of complete remission with medications in temporal lobe epilepsy is poor. Less is known about remission rates in patients who are not surgical candidates. In this study, we evaluated the outcome of medical treatment in patients with medically refractory partial epilepsy who were evaluated for possible epilepsy surgery but deemed to be inadequate surgical candidates. Methods: A retrospective chart review and telephone survey with a self-rating questionnaire were completed for all patients who underwent epilepsy surgery evaluation but were not ultimately offered surgical treatment at the University of Michigan from 1990 through 1998. We assessed changes in seizure frequency and type, imaging characteristics, ictal recordings, interim medication history, and subjective changes in quality of life. Results: Thirty-four subjects were available for follow-up study, at an average of >4 years after surgical evaluation. A significant reduction in seizure frequency was noted at the time of follow-up compared with that at the time of surgical evaluation. Of patients, 21% achieved seizure remission and remained seizure free for an average of 2.5 years. Four of the seven seizure-free patients attributed their remission to new antiepileptic drugs (AEDs). On a global self-rating item, 15 of 34, or 44%, felt more or much more satisfied with their lives, and 41% felt their quality of life was stable. Conclusions: A surprisingly large number of patients we surveyed, with refractory partial epilepsy not eligible for surgical management, reported reduced seizure frequency at follow-up, and 21% were seizure free. Our findings suggest that the long-term prognosis in patients with refractory partial epilepsy who are not surgical candidates may be more positive than might be generally expected.en_US
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dc.format.mimetypeapplication/pdf
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dc.publisherBlackwell Science Incen_US
dc.rights2003 International League Against Epilepsyen_US
dc.subject.otherEpilepsyen_US
dc.subject.otherPartialen_US
dc.subject.otherTemporal Lobeen_US
dc.subject.otherEfficacyen_US
dc.subject.otherQuality of Lifeen_US
dc.titleLong-term Outcome of Nonsurgical Candidates with Medically Refractory Localization-related Epilepsyen_US
dc.typeArticleen_US
dc.rights.robotsIndexNoFollowen_US
dc.subject.hlbsecondlevelMedicine (General)en_US
dc.subject.hlbtoplevelHealth Sciencesen_US
dc.description.peerreviewedPeer Revieweden_US
dc.contributor.affiliationumDepartment of Neurology, University of Michigan Medical School, Ann Arbor, Michiganen_US
dc.contributor.affiliationotherDepartment of Neurology, Vanderbilt University, Nashville, Tennessee, both in U.S.A.en_US
dc.identifier.pmid14636329en_US
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/65701/1/j.0013-9580.2003.15003.x.pdf
dc.identifier.doi10.1111/j.0013-9580.2003.15003.xen_US
dc.identifier.sourceEpilepsiaen_US
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dc.owningcollnameInterdisciplinary and Peer-Reviewed


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