Epilepsy Surgery Shows Long-Term Survival Benefits

Medscape

3 days ago

TOPLINE:
Surgery led to a reduction in premature mortality among adults with drug-resistant focal epilepsy beyond 15 years and gradually normalised their long-term survival to more closely resemble that of the general population. Older age at surgery, malformations of cortical development (MCD), and poor seizure control were independent predictors of epilepsy-related mortality.
METHODOLOGY:
Researchers evaluated data of 1062 adults (mean age at surgery, 36 ± 10 years) who underwent surgery for drug-resistant focal epilepsy at the National Hospital for Neurology and Neurosurgery in London between February 1990 and November 2022.
They assessed postoperative mortality by examining the cumulative incidence, temporal patterns, and causes of death and by comparing observed mortality with population-based expectations.
Key predictors of cause-specific mortality were also evaluated using Fine-Gray and cause-specific hazard models.
Postoperative seizure outcomes were classified annually using the International League Against Epilepsy (ILAE) surgery outcome scale (outcome class [OC], 1-6).
TAKEAWAY:
Epilepsy-related deaths occurred in 36 adults (2.52 per 1000 person-years), of which 18 deaths (1.26 per 1000 person-years) were due to epilepsy alone and the remaining 18 were due to underlying neurologic disease (0.7%), suicide (0.7%), and aspiration pneumonia (0.4%).
Epilepsy-related deaths were reported in 25% of adults who were followed up for more than 15 years vs 75% of those who were followed up for 15 years or less (P = .006). Among those who were followed up for more than 15 years, the standardised mortality ratio was 0.65 (95% CI, 0.46-0.89), indicating that long-term survival aligns with that of the general population.
In the Fine-Gray model, older age at surgery (subdistribution hazard ratio [SHR], 1.04; P = .01), MCD (SHR, 5.2; P = .01), and poor seizure outcomes (OC ≥ 4; SHR, 2.96; P = .04) were independent predictors of epilepsy-related mortality.
In the cause-specific hazard model, older age at surgery (cause-specific hazard ratio [CSHR], 1.05; P = .006), MCD (CSHR, 5.00; P = .017), and poor seizure outcomes (OC ≥ 4; CSHR, 2.90; P = .029) were independently associated with epilepsy-related mortality.
IN PRACTICE:
"[The study] findings underscore the potential of epilepsy surgery to modify long-term health trajectories and support the value of early surgical referral and systematic follow-up in optimizing outcomes," the authors wrote.
SOURCE:
This study was led by Giorgio Fiore, UCL Queen Square Institute of Neurology, London, England. It was published online on July 25, 2025, in Epilepsia.
LIMITATIONS:
The study's observational design limited the detailed analysis of the association between older age at surgery and an increased risk for epilepsy-related mortality. The ILAE outcome scale was used to classify seizure outcomes, which limited the ability to assess the specific effect of focal to bilateral tonic-clonic seizures on mortality. This study included only a small number of patients with MCD, restricting conclusion on the pathology-related survival risk.
DISCLOSURES:
This study was supported by the National Institute for Health and Care Research University College London Hospitals/University College London Biomedical Research Centre. The authors declared having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.