• Long-term survival after adult...

*Result*: Long-term survival after adult epilepsy surgery: Mortality and predictors in a large cohort.

Title:
Long-term survival after adult epilepsy surgery: Mortality and predictors in a large cohort.
Authors:
Fiore G; UCL Queen Square Institute of Neurology, London, UK.; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.; Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., de Tisi J; UCL Queen Square Institute of Neurology, London, UK., O'Keeffe A; School of Mathematical Sciences, University of Nottingham, Nottingham, UK.; UCL Institute of Epidemiology and Health Care, London, UK., Miserocchi A; UCL Queen Square Institute of Neurology, London, UK.; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK., McEvoy AW; UCL Queen Square Institute of Neurology, London, UK.; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK., Sander JW; UCL Queen Square Institute of Neurology, London, UK.; Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Duncan JS; UCL Queen Square Institute of Neurology, London, UK.; MRI Centre, Chalfont Centre for Epilepsy, UK.
Source:
Epilepsia [Epilepsia] 2025 Nov; Vol. 66 (11), pp. 4198-4210. Date of Electronic Publication: 2025 Jul 25.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Blackwell Science Country of Publication: United States NLM ID: 2983306R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1167 (Electronic) Linking ISSN: 00139580 NLM ISO Abbreviation: Epilepsia Subsets: MEDLINE
Imprint Name(s):
Publication: Malden, MA : Blackwell Science
Original Publication: Copenhagen : Munskgaard
MeSH Terms:
Drug Resistant Epilepsy*/surgery , Drug Resistant Epilepsy*/mortality , Epilepsy*/surgery , Epilepsy*/mortality, Sudden Unexpected Death in Epilepsy/epidemiology ; Humans ; Male ; Female ; Adult ; Middle Aged ; Cohort Studies ; Young Adult ; Adolescent ; Follow-Up Studies ; Aged
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Grant Information:
UCLH Biomedical Research Centre
Contributed Indexing:
Keywords: SUDEP; epilepsy; mortality; surgery; survival
Entry Date(s):
Date Created: 20250725 Date Completed: 20251128 Latest Revision: 20251130
Update Code:
20260130
PubMed Central ID:
PMC12661268
DOI:
10.1111/epi.18564
PMID:
40711417
Database:
MEDLINE

*Further Information*

*Objective: Long-term survival data in adults undergoing surgery for drug-resistant focal epilepsy remain limited. We examined mortality patterns and predictors in a large cohort followed for over 30 years.
Methods: Adults who underwent epilepsy surgery (1990-2022) were analyzed. Prospectively collected clinical, surgical, and outcome data were included. We estimated the cumulative incidence of mortality and standardized mortality ratios (SMRs) for the cohort. Predictors of epilepsy-related and non-epilepsy-related deaths were identified using Fine-Gray and cause-specific hazard models.
Results: A total of 1062 individuals contributed 14 279 person-years of follow-up (median, 13 years). The overall mortality rate was 6.16 per 1000 person-years, with 2.52 per 1000 person-years due to epilepsy-related deaths, including 0.84 per 1000 person-years from sudden unexpected death in epilepsy (SUDEP). Epilepsy-related deaths were more frequent within the first 15 years post-surgery (p = 0.006). The overall SMR was 1.12 (95% confidence interval [CI]: 0.90-1.38), and 0.65 (95% CI: 0.46-0.89) among individuals followed for more than 15 years. Independent predictors of epilepsy-related mortality were older age at surgery, cortical malformations, and poor post-operative seizure control (International League Against Epilepsy [ILAE] outcome class ≥4). Non-epilepsy-related mortality was driven primarily by older age at surgery.
Significance: Epilepsy surgery is associated with reduced premature mortality and increasingly normalized long-term survival. Age at surgery, post-operative seizure control, and pathological findings are key determinants of survival, highlighting opportunities to improve surgical outcomes further.
(© 2025 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)*