The duration of temporal lobe epilepsy and seizure outcome after epilepsy surgery.

UNLABELLED: To assess the effect of the duration of epilepsy on the outcome of epilepsy surgery in non-lesional medically refractory temporal lobe epilepsy we reviewed the outcome of 76 patients. METHODS: All patients had anterior temporal resections for "non-lesional" temporal epilepsy (excluding any patient with tumours or vascular malformations but including patients with hippocampal sclerosis). Outcome at one year was assessed using Engel's scale. RESULTS: 67% had a good outcome (Engel I or II). The mean duration of epilepsy was 23.0 years (range 2.9-46.9 years). Overall, there was no significant difference between patients with good outcome (mean duration 22.4 years) and poor outcome (mean duration 24.2 years) (p=0.49). The proportion of patients with good outcome was slightly higher in the shorter duration groups. (Duration less than 10 years 75%, 10-19 years 71%, 20-29 years 65%, 30-39 years 62%, and 40-49 years 60% good outcome, p=0.95). CONCLUSION: We found no significant associations between outcome and duration of epilepsy.

Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trial.

BACKGROUND: Surgical intervention for advanced Parkinson's disease is an option if medical therapy fails to control symptoms adequately. We aimed to assess whether surgery and best medical therapy improved self-reported quality of life more than best medical therapy alone in patients with advanced Parkinson's disease. METHODS: The PD SURG trial is an ongoing randomised, open-label trial. At 13 neurosurgical centres in the UK, between November, 2000, and December, 2006, patients with Parkinson's disease that was not adequately controlled by medical therapy were randomly assigned by use of a computerised minimisation procedure to immediate surgery (lesioning or deep brain stimulation at the discretion of the local clinician) and best medical therapy or to best medical therapy alone. Patients were analysed in the treatment group to which they were randomised, irrespective of whether they received their allocated treatment. The primary endpoint was patient self-reported quality of life on the 39-item Parkinson's disease questionnaire (PDQ-39). Changes between baseline and 1 year were compared by use of t tests. This trial is registered with Current Controlled Trials, number ISRCTN34111222. FINDINGS: 366 patients were randomly assigned to receive immediate surgery and best medical therapy (183) or best medical therapy alone (183). All patients who had surgery had deep brain stimulation. At 1 year, the mean improvement in PDQ-39 summary index score compared with baseline was 5.0 points in the surgery group and 0.3 points in the medical therapy group (difference -4.7, 95% CI -7.6 to -1.8; p=0.001); the difference in mean change in PDQ-39 score in the mobility domain between the surgery group and the best medical therapy group was -8.9 (95% CI -13.8 to -4.0; p=0.0004), in the activities of daily living domain was -12.4 (-17.3 to -7.5; p<0.0001), and in the bodily discomfort domain was -7.5 (-12.6 to -2.4; p=0.004). Differences between groups in all other domains of the PDQ-39 were not significant. 36 (19%) patients had serious surgery-related adverse events; there were no suicides but there was one procedure-related death. 20 patients in the surgery group and 13 in the best medical therapy group had serious adverse events related to Parkinson's disease and drug treatment. INTERPRETATION: At 1 year, surgery and best medical therapy improved patient self-reported quality of life more than best medical therapy alone in patients with advanced Parkinson's disease. These differences are clinically meaningful, but surgery is not without risk and targeting of patients most likely to benefit might be warranted.

The long-term outcome of microvascular decompression for trigeminal neuralgia.

OBJECTIVE: Evaluation of the effectiveness of Microvascular Decompression (MVD) for Trigeminal Neuralgia (TGN), with emphasis on patient's perception of outcome, and satisfaction with the procedure. MATERIALS AND METHODS: A cohort of 372 MVD operations carried out between 1982 and 2005 were reviewed, contact could be attempted with 319 patients. Questionnaires assessing the patient's perception of outcome returned by 266 patients (71%). statistical analysis of the data was carried out using a cox proportional-hazard regression analysis. Anticipated outcome measures: Time to pain recurrence; predictive value of imaging, operative findings and complications; patients' satisfaction, and outcome of revision MVD. RESULTS: Complete pain relief (off medication) achieved in 71% of patients at 10 years. Overall 84% of responders to questionnaires expressed satisfaction with the operative outcome, the mean duration of TGN was 80 months and mean post-operative follow-up of 7 years. No mortality reported in this series. CONCLUSION: This is a large review of MVD, which confirms the long-term effectiveness of the procedure, and uniquely reflects patient's perception of the operation. Predictors of favourable outcome were shorter preoperative duration of TGN, older age at time of MVD, typical features, and vascular compression; moreover, complications, and previous neurodestructive procedures did not show significant effect on long-term pain relief. Satisfaction with MVD was exclusively related to long-term pain relief without medications.