| 1. |
- Andersson, Klara, et al.
(författare)
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Socioeconomic outcome and access to care in adults with epilepsy in Sweden: A nationwide cohort study.
- 2020
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Ingår i: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 74, s. 71-76
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Tidskriftsartikel (refereegranskat)abstract
- Epilepsy has well-documented associations with low income and low education levels, but the impact of a patient's socioeconomic standing (SES) on the effects of epilepsy have been less studied.We performed a register-based cross-sectional study and asked if SES was associated with more severe epilepsy or limited access to care in Sweden, where health care is universal, and if socioeconomic outcomes (employment and income) differed for persons with epilepsy (PWE) with different levels of educational attainment. The study cohort consisted of all adult patients with an epilepsy diagnosis in the Swedish patient register in 2000-2015 (n = 126,406) and controls (n = 379,131) matched for age, gender, and place of birth.Somatic and psychiatric comorbidities were more common in PWE, while education and income levels were lower. Among PWE, hospitalizations were more common in persons with lower income or education. Having at least one prescription written by a neurologist in the study period was more common in the high-income and high-education groups. Finally, although low educational attainment was associated with low levels of income and inversely associated with employment in both persons with epilepsy and controls, regression analyses demonstrated that these associations were much more noticeable in cases than controls.We conclude that both the severity and consequences of epilepsy are greater in persons of low SES, even in a country with universal health care. This indicates that universal access may not be sufficient to mitigate socioeconomic inequity in epilepsy.
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| 3. |
- Bjellvi, Johan, et al.
(författare)
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Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study.
- 2020
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Ingår i: Neurosurgery. - : Ovid Technologies (Wolters Kluwer Health). - 1524-4040 .- 0148-396X. ; 87:4, s. 704-711
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Tidskriftsartikel (refereegranskat)abstract
- Increased seizure frequency and new-onset tonic-clonic seizures (TCS) have been reported after epilepsy surgery.To analyze potential risk factors for these outcomes in a large cohort.We studied prospectively collected data in the Swedish National Epilepsy Surgery Register on increased seizure frequency and new-onset TCS after epilepsy surgery 1990-2015.Two-year seizure outcome was available for 1407 procedures, and data on seizure types for 1372. Increased seizure frequency at follow-up compared to baseline occurred in 56 cases (4.0%) and new-onset TCS in 53 (3.9%; 6.6% of the patients without preoperative TCS). Increased frequency was more common in reoperations compared to first surgeries (7.9% vs 3.1%; P=.001) and so too for new-onset TCS (6.7% vs 3.2%; P=.017). For first surgeries, binary logistic regression was used to analyze predictors for each outcome. In univariable analysis, significant predictors for increased seizure frequency were lower age of onset, lower age at surgery, shorter epilepsy duration, preoperative neurological deficit, intellectual disability, high preoperative seizure frequency, and extratemporal procedures. For new-onset TCS, significant predictors were preoperative deficit, intellectual disability, and nonresective procedures. In multivariable analysis, independent predictors for increased seizure frequency were lower age at surgery (odds ratio (OR) 0.70 per increasing 10-yr interval, 95% CI 0.53-0.93), type of surgery (OR 0.42 for temporal lobe resections compared to other procedures, 95% CI 0.19-0.92), and for new-onset TCS preoperative neurological deficit (OR 2.57, 95% CI 1.32-5.01).Seizure worsening is rare but should be discussed when counseling patients. The identified risk factors may assist informed decision-making before surgery.
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| 4. |
- Edelvik, Anna, 1971, et al.
(författare)
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Health-related quality of life and emotional well-being after epilepsy surgery: A prospective, controlled, long-term follow-up
- 2017
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Ingår i: Epilepsia. - : Wiley. - 0013-9580. ; 58:10, s. 1706-1715
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo evaluate health-related quality of life (HRQOL) and emotional well-being in resective epilepsy surgery and nonoperated patients at long-term follow-up. MethodsThis is a prospective cohort study where patients undergoing presurgical work-up during 1995-1998 completed the Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression scale (HAD) at baseline, and 2 and 14years after resective surgery or presurgical evaluation (nonoperated patients). SF-36 scores were compared to a normative population. Proportions of patients reaching HRQOL changes of minimum clinically important difference (MCID) were calculated. ResultsAt 14-year follow-up, operated patients scored equal to or better than the normative sample on all SF-36 domains except Social Functioning and Mental Health. Physical component summary (PCS) was better and mental component summary (MCS) was worse than for the normative sample. Nonoperated patients scored worse than the normative sample on five of eight domains, and on PCS and MCS. Change in seizure status from 2 to 14years did not affect PCS or MCS means. Improvement reaching MCID from baseline to long-term was seen in 50% (PCS) and 47% (MCS) of operated and in 33% (PCS) and 38% (MCS) of nonoperated patients. Worsening was seen in 18% (PCS) and 22% (MCS) of operated and in 38% (PCS) and 38% (MCS) of nonoperated patients. Differences between groups were nonsignificant. HAD scores did not differ between groups, and the numbers of possible or probable cases were low. Patient satisfaction with surgery was higher in operated seizure-free patients. Only 5% of all operated patients considered surgery not to be overall beneficial. SignificanceAt the group level, HRQOL was stable 14years after surgery compared to after 2years. Social Functioning and Mental Health were still below, but other domains were similar to the normative sample. Individual patterns did not follow seizure outcome changes, indicating that multiple factors are important for long-term HRQOL.
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| 5. |
- Edelvik, Anna, 1971, et al.
(författare)
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Hälften är långsiktigt fria från anfall efter epilepsikirurgi
- 2018
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Ingår i: Läkartidningen. - 0023-7205. ; 115:21
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Forskningsöversikt (refereegranskat)abstract
- Personer med läkemedelsresistent epilepsi bör remitteras till regionala epilepsiteam för utredning och bedömning av behandlingsalternativ, bland annat epilepsikirurgi. Om magnetresonanstomografi visar en epileptogen lesion som är åtkomlig för kirurgi är operation ett effektivt behandlingsalternativ, och en epilepsikirurgisk utredning kan vara relativt begränsad. Även om magnetresonanstomografi bedöms normal kan en epilepsikirurgisk utredning vara aktuell, men är då mera omfattande. Små barn med läkemedelsresistent epilepsi bör tidigt remitteras till regionala epilepsiteam. Ungefär hälften av dem som opereras blir anfallsfria på lång sikt, med bättre resultat för dem som opererats för välavgränsade lesioner.
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| 7. |
- Edelvik, Anna, 1971, et al.
(författare)
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Prospective and longitudinal long-term employment outcomes after resective epilepsy surgery
- 2015
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Ingår i: Neurology. - : Ovid Technologies (Wolters Kluwer Health). - 0028-3878 .- 1526-632X. ; 85:17, s. 1482-1490
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To investigate long-term employment outcomes after resective epilepsy surgery in a national population-based cohort of adults.Methods:In the Swedish National Epilepsy Surgery Register, all adults who were operated with resective epilepsy surgery from 1995 to 2010 were identified. Two-year follow-up was available for 473/496, 5-year follow-up for 220/240, 10-year follow-up for 240/278, and 15-year follow-up for 85/109 patients.Results:There were no significant changes in employment outcome over time at group level, but for those with full-time employment at baseline, 79%, 79%, 57%, and 47% of seizure-free patients were in full-time work at 2-, 5-, 10-, and 15-year follow-up, compared to patients with benefits at baseline, where 16%, 27%, 31%, and 33% of seizure-free patients worked full time at these time points (p = 0.018 at 10 years). More patients with full-time work had ability to drive, a family of their own, and higher educational status than patients in part-time work or on benefits. Univariate predictors for employment at long term were having employment preoperatively, higher education, favorable seizure outcome, male sex, and younger age at surgery. Multivariate predictors were having employment preoperatively, favorable seizure outcome, and younger age.Conclusions:The best vocational outcomes occurred in seizure-free patients who were employed or students at baseline, which may reflect a higher general psychosocial level of function. Younger age also predicted better employment outcomes and it therefore seems plausible that early referral for surgery could contribute to better vocational outcomes.
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| 9. |
- Granthon, Cecilia, 1986, et al.
(författare)
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Reduced long-term mortality after successful resective epilepsy surgery: a population-based study.
- 2024
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Ingår i: Journal of neurology, neurosurgery, and psychiatry. - : BMJ Publishing Group Ltd. - 0022-3050 .- 1468-330X. ; 95:3, s. 249-255
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Tidskriftsartikel (refereegranskat)abstract
- We investigated all-cause and epilepsy-related mortality in patients operated with resective epilepsy surgery and in non-operated patients with drug-resistant epilepsy. Our hypothesis was that patients who proceed to surgery have lower mortality over time compared with non-operated patients.Data from 1329 adults and children from the Swedish National Epilepsy Surgery Register and 666 patients with drug-resistant epilepsy who had undergone presurgical work-up but not been operated were analysed. The operated patients had follow-ups between 2 and 20 years. We used the Swedish Cause of Death Register to identify deaths. Autopsy reports were collected for patients with suspected sudden unexpected death in epilepsy (SUDEP). Kaplan-Meier and Cox regression analyses were performed to identify predictors for mortality and SUDEP.SUDEP accounted for 30% of all deaths. Surgery was associated with lower all-cause mortality (HR 0.7, 95% CI 0.5 to 0.9), also when adjusted for age, sex and tonic-clonic seizures at inclusion. The benefit of surgery seemed to persist and possibly even increase after 15 years of follow-up. Risk factors of mortality for operated patients were persisting seizures and living alone. Of the operated patients, 37% had seizures, and these had a higher risk of mortality (HR 2.1, 95% CI 1.4 to 3.0) and SUDEP (HR 3.5, 95% CI 1.7 to 7.3) compared with patients with seizure freedom at last follow-up.In this large population-based epilepsy surgery cohort, operated patients had a lower all-cause mortality compared with non-operated patients with drug-resistant epilepsy. Seizure freedom was the most important beneficial factor for both all-cause mortality and SUDEP among operated patients.
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| 10. |
- Hahne, Oscar, et al.
(författare)
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Epilepsy surgery in patients with hypothalamic hamartomas-Population-based two-year and long-term outcomes
- 2023
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Ingår i: European Journal of Paediatric Neurology. - 1090-3798. ; 46, s. 24-29
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Hypothalamic hamartomas are benign lesions associated with drug resistant epilepsy. Surgical treatment has become an increasingly utilised approach with promising results. This study aims to evaluate seizure outcome and complications after surgery in a population-based series of patients with intractable epilepsy and hypothalamic hamartoma.Methods: All patients with hypothalamic hamartoma treated with epilepsy surgery in Sweden since 1995 with at least two years of follow-up were included. Preoperative, two-, five- and ten-year prospective longitudinal data were collected from The Swedish National Epilepsy Surgery Register. Data included seizure types and frequency, duration of epilepsy, clinical characteristics, neurological deficits, cognitive level and complications. In a subgroup from Gothenburg, we also analysed data not included in the register such as classification of hamartomas, surgical procedures and gelastic seizures.Results: Eighteen patients were operated on during the period 1995-2020. The median age at epilepsy onset was 6 months and age at surgery 13 years. Four were seizure free and another four had >75% reduction in seizure frequency at the two-year follow-up. Two of the 13 patients with a long-term follow-up (five or ten years) were seizure-free and four had >75% reduction in seizure frequency. Three had an increased seizure frequency. No major complications were seen. Five had minor complications. In the Gothenburg subgroup all had open pterional disconnection or intraventricular endoscopic disconnection. Six of 12 were free from gelastic seizures at the two-year follow-up and six of eight at the long-term follow-up. Conclusion: This study supports surgical treatment of hypothalamic hamartomas as a safe method with a low risk of permanent complications. The seizure reduction seems to be persistent over time.
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