Central lobe epilepsy surgery - (functional) results and how to evaluate them

OBJECT: To evaluate whether central lobe epilepsy (CLE) surgery in the pericentral area implies inevitable function loss and to determine how postsurgical functional outcomes are perceived by the patient.

METHODS: We included all 22 people with epilepsy (PWE) who received central lobe epilepsy (CLE) surgery in the pre- and postcentral gyri between 1995 and 2015 in the University Medical Center Utrecht. We determined function loss and followed-up on quality of life (AQoL-8D), mobility (Rivermead Mobility Index RMI) and self-evaluation of the surgery. To compare this with the literature, a systematic review was conducted, with specific regard for studies that included functional outcome.

RESULTS: Our own cohort showed newly developed functional loss in 54.4% postoperatively. Follow-up questionnaires were returned by 11/19 PWE (the other 3 could not be contacted). The mean AQoL-8d score was 0.74 (SD 0.16) and the mean RMI score was 13.7 (SD 3.0). This mean AQoL-8d was slightly lower than the Western mean population scores (0.86 and 0.87 respectively). RMI scores and postoperative functional deficits were both significantly related to how well PWE scored on the AQoL-8d. 72.7% of the PWE became seizure free after surgery (Engel class 1A). All PWE were happy with the CLE surgery and would recommend this type of surgery to other PWE. Becoming seizure-free, gaining better functioning and having more energy were reported as the most important reasons. The literature provided 475 unique papers, of which 25 were selected for critical appraisal. Six studies were of adequate quality and provided sufficient information to extract results. Prevalence of postoperative neurological deficit varied between 0 and 50%. No information is given on patient's perceptions.

CONCLUSIONS: About half of central lobe resections do not result in new neurological deficits. The patient's perspective is important in CLE surgery, but neglected in the literature. PWE may report being satisfied with the results of surgery despite new deficits and impact on quality of life. Counseling in CLE surgery should take these findings into account. Neurologists and neurosurgeons should not by default refrain from CLE surgery and think a PWE will not accept a deficit.