A novel postoperative seizure classification for long-term mortality of patients with intractable epilepsy: Comparison with the engel system

Yang Hsin Shih, Amy Ming Fang Yen, Der Jen Yen, Ling Pin Hung, Hsiu Hsi Chen, Horng Huei Liou

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: To explore the association of clinical seizure pattern with the long-term prognosis after epilepsy surgery is important for patient counseling and risk management. OBJECTIVE: To study the long-term mortality after surgery of intractable epilepsy patients with a novel classification of clinical patterns by long-term frequency and duration of seizure compared with the Engel classification. METHODS: We conducted a longitudinal cohort study by enrolling 280 patients with epilepsy who underwent anterior temporal lobectomy between 1987 and 2002. In addition to the Engel classification, we proposed a novel classification of clinical patterns pertaining to at least 1 year of follow-up of the frequency and duration of seizures after surgery (inactive, delayed, intermittent, and intensive groups). We followed the vital status of these members until 2007 to obtain a 15-year survival rate for each classification. The standardized mortality ratio and hazard ratios with proportional hazards regression model by the extent of severity were estimated. RESULTS: The overall 15-year survival rate for patients who underwent anterior temporal lobectomy was 95.1%. The standardized mortality ratio estimates (95% confidence interval) for our classification showed a gradient relationship from 0.6 (0.1-2.3), 2.5 (0.7-6.3), 7.6 (0.8-27.3), and 8.9 (3.2-19.3) for inactive, delayed, intermittent, and intensive groups, respectively (Trend test, P = .04), whereas the corresponding estimates were 0.8 (0.2-2.2), 5.9 (1.2-17.2), 6.7 (2.5-14.7), and 7.2 (0.8-25.9) for Engel I to IV, respectively, which showed a less increasing trend (Trend test, P = .82). Similar findings were noted for hazard ratios for the 2 classifications. CONCLUSION: The proposed novel classification with long-term observed frequency and duration of seizures after surgery is more informative for predicting long-term mortality than the Engel classification.

Original languageEnglish
Pages (from-to)64-70
Number of pages7
JournalNeurosurgery
Volume69
Issue number1
DOIs
Publication statusPublished - Jul 2011
Externally publishedYes

Fingerprint

Seizures
Mortality
Anterior Temporal Lobectomy
Epilepsy
Survival Rate
Drug Resistant Epilepsy
Risk Management
Proportional Hazards Models
Longitudinal Studies
Counseling
Cohort Studies
Confidence Intervals

Keywords

  • Engel classification
  • Epilepsy surgery
  • Mortality
  • Prognosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

A novel postoperative seizure classification for long-term mortality of patients with intractable epilepsy : Comparison with the engel system. / Shih, Yang Hsin; Yen, Amy Ming Fang; Yen, Der Jen; Hung, Ling Pin; Chen, Hsiu Hsi; Liou, Horng Huei.

In: Neurosurgery, Vol. 69, No. 1, 07.2011, p. 64-70.

Research output: Contribution to journalArticle

Shih, Yang Hsin ; Yen, Amy Ming Fang ; Yen, Der Jen ; Hung, Ling Pin ; Chen, Hsiu Hsi ; Liou, Horng Huei. / A novel postoperative seizure classification for long-term mortality of patients with intractable epilepsy : Comparison with the engel system. In: Neurosurgery. 2011 ; Vol. 69, No. 1. pp. 64-70.
@article{6610108cb5a644e3973cbbb1786fca4f,
title = "A novel postoperative seizure classification for long-term mortality of patients with intractable epilepsy: Comparison with the engel system",
abstract = "BACKGROUND: To explore the association of clinical seizure pattern with the long-term prognosis after epilepsy surgery is important for patient counseling and risk management. OBJECTIVE: To study the long-term mortality after surgery of intractable epilepsy patients with a novel classification of clinical patterns by long-term frequency and duration of seizure compared with the Engel classification. METHODS: We conducted a longitudinal cohort study by enrolling 280 patients with epilepsy who underwent anterior temporal lobectomy between 1987 and 2002. In addition to the Engel classification, we proposed a novel classification of clinical patterns pertaining to at least 1 year of follow-up of the frequency and duration of seizures after surgery (inactive, delayed, intermittent, and intensive groups). We followed the vital status of these members until 2007 to obtain a 15-year survival rate for each classification. The standardized mortality ratio and hazard ratios with proportional hazards regression model by the extent of severity were estimated. RESULTS: The overall 15-year survival rate for patients who underwent anterior temporal lobectomy was 95.1{\%}. The standardized mortality ratio estimates (95{\%} confidence interval) for our classification showed a gradient relationship from 0.6 (0.1-2.3), 2.5 (0.7-6.3), 7.6 (0.8-27.3), and 8.9 (3.2-19.3) for inactive, delayed, intermittent, and intensive groups, respectively (Trend test, P = .04), whereas the corresponding estimates were 0.8 (0.2-2.2), 5.9 (1.2-17.2), 6.7 (2.5-14.7), and 7.2 (0.8-25.9) for Engel I to IV, respectively, which showed a less increasing trend (Trend test, P = .82). Similar findings were noted for hazard ratios for the 2 classifications. CONCLUSION: The proposed novel classification with long-term observed frequency and duration of seizures after surgery is more informative for predicting long-term mortality than the Engel classification.",
keywords = "Engel classification, Epilepsy surgery, Mortality, Prognosis",
author = "Shih, {Yang Hsin} and Yen, {Amy Ming Fang} and Yen, {Der Jen} and Hung, {Ling Pin} and Chen, {Hsiu Hsi} and Liou, {Horng Huei}",
year = "2011",
month = "7",
doi = "10.1227/NEU.0b013e3182134126",
language = "English",
volume = "69",
pages = "64--70",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - A novel postoperative seizure classification for long-term mortality of patients with intractable epilepsy

T2 - Comparison with the engel system

AU - Shih, Yang Hsin

AU - Yen, Amy Ming Fang

AU - Yen, Der Jen

AU - Hung, Ling Pin

AU - Chen, Hsiu Hsi

AU - Liou, Horng Huei

PY - 2011/7

Y1 - 2011/7

N2 - BACKGROUND: To explore the association of clinical seizure pattern with the long-term prognosis after epilepsy surgery is important for patient counseling and risk management. OBJECTIVE: To study the long-term mortality after surgery of intractable epilepsy patients with a novel classification of clinical patterns by long-term frequency and duration of seizure compared with the Engel classification. METHODS: We conducted a longitudinal cohort study by enrolling 280 patients with epilepsy who underwent anterior temporal lobectomy between 1987 and 2002. In addition to the Engel classification, we proposed a novel classification of clinical patterns pertaining to at least 1 year of follow-up of the frequency and duration of seizures after surgery (inactive, delayed, intermittent, and intensive groups). We followed the vital status of these members until 2007 to obtain a 15-year survival rate for each classification. The standardized mortality ratio and hazard ratios with proportional hazards regression model by the extent of severity were estimated. RESULTS: The overall 15-year survival rate for patients who underwent anterior temporal lobectomy was 95.1%. The standardized mortality ratio estimates (95% confidence interval) for our classification showed a gradient relationship from 0.6 (0.1-2.3), 2.5 (0.7-6.3), 7.6 (0.8-27.3), and 8.9 (3.2-19.3) for inactive, delayed, intermittent, and intensive groups, respectively (Trend test, P = .04), whereas the corresponding estimates were 0.8 (0.2-2.2), 5.9 (1.2-17.2), 6.7 (2.5-14.7), and 7.2 (0.8-25.9) for Engel I to IV, respectively, which showed a less increasing trend (Trend test, P = .82). Similar findings were noted for hazard ratios for the 2 classifications. CONCLUSION: The proposed novel classification with long-term observed frequency and duration of seizures after surgery is more informative for predicting long-term mortality than the Engel classification.

AB - BACKGROUND: To explore the association of clinical seizure pattern with the long-term prognosis after epilepsy surgery is important for patient counseling and risk management. OBJECTIVE: To study the long-term mortality after surgery of intractable epilepsy patients with a novel classification of clinical patterns by long-term frequency and duration of seizure compared with the Engel classification. METHODS: We conducted a longitudinal cohort study by enrolling 280 patients with epilepsy who underwent anterior temporal lobectomy between 1987 and 2002. In addition to the Engel classification, we proposed a novel classification of clinical patterns pertaining to at least 1 year of follow-up of the frequency and duration of seizures after surgery (inactive, delayed, intermittent, and intensive groups). We followed the vital status of these members until 2007 to obtain a 15-year survival rate for each classification. The standardized mortality ratio and hazard ratios with proportional hazards regression model by the extent of severity were estimated. RESULTS: The overall 15-year survival rate for patients who underwent anterior temporal lobectomy was 95.1%. The standardized mortality ratio estimates (95% confidence interval) for our classification showed a gradient relationship from 0.6 (0.1-2.3), 2.5 (0.7-6.3), 7.6 (0.8-27.3), and 8.9 (3.2-19.3) for inactive, delayed, intermittent, and intensive groups, respectively (Trend test, P = .04), whereas the corresponding estimates were 0.8 (0.2-2.2), 5.9 (1.2-17.2), 6.7 (2.5-14.7), and 7.2 (0.8-25.9) for Engel I to IV, respectively, which showed a less increasing trend (Trend test, P = .82). Similar findings were noted for hazard ratios for the 2 classifications. CONCLUSION: The proposed novel classification with long-term observed frequency and duration of seizures after surgery is more informative for predicting long-term mortality than the Engel classification.

KW - Engel classification

KW - Epilepsy surgery

KW - Mortality

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=79958849050&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79958849050&partnerID=8YFLogxK

U2 - 10.1227/NEU.0b013e3182134126

DO - 10.1227/NEU.0b013e3182134126

M3 - Article

C2 - 21358356

AN - SCOPUS:79958849050

VL - 69

SP - 64

EP - 70

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 1

ER -