{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:40:28Z","timestamp":1786977628636,"version":"build-2736575974"},"reference-count":19,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T00:00:00Z","timestamp":1757116800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T00:00:00Z","timestamp":1757116800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"published-print":{"date-parts":[[2025,12]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n Despite pharmacological advances in epilepsy treatment, one\u2010third of patients remain pharmacoresistant and may require surgery. Despite extensive literature on epilepsy surgery, studies with follow\u2010ups longer than 5\u2009years are rare. Our goal was to analyze the outcomes of patients undergoing epilepsy surgery at our center, with a minimum follow\u2010up of 15\u2009years.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This was a retrospective study of prospectively collected data. We used the Engel classification to assess seizure freedom, performed univariate descriptive analysis of the variables of interest, and applied appropriate correlation tests for nominal and categorical variables, with statistical significance set at 0.05.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We included 160 patients with a minimum follow\u2010up of 15\u2009years. A total of 105 (70%) patients underwent resective surgeries, the most common being lesionectomy (46.7%), followed by anterior temporal lobectomy with amygdalectomy (21.9%). Among resective surgeries, 73.6% used intraoperative ECOG. Most surgeries were in the temporal lobe (68.8%), and mesial sclerosis was the most frequent etiology (33.8%), followed by long\u2010term epilepsy\u2010associated tumors (LEAT) (25.6%). Seizure freedom at 15\u2009years was achieved by 57.5% of patients, and most of the remaining patients (63.2%) had rare disabling seizures. The majority (65%) discontinued at least one ASM. Temporal surgeries (\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n (1)\u2009=\u20098.444,\n p<\/jats:italic>\n \u2009<\u20090.05), left\u2010sided surgeries (\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n (1)\u2009=\u20096.436,\n p<\/jats:italic>\n \u2009=\u20090.04), mesial sclerosis (\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n (1)\u2009=\u200950.870,\n p<\/jats:italic>\n \u2009=\u20090.024), and the use of intraoperative ECOG (\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n (1)\u2009=\u200923.235,\n p<\/jats:italic>\n \u2009<\u20090.001) were associated with a better prognosis. No differences in outcome were found between the different temporal lobe surgeries (Fisher's exact test value\u2009=\u20090.859,\n p<\/jats:italic>\n \u2009=\u20090.659).\n <\/jats:p>\n <\/jats:sec>\n \n Significance<\/jats:title>\n Appropriate referral to a refractory epilepsy center permits a multidisciplinary approach that can result in long\u2010term seizure freedom for most patients undergoing surgery, especially for left\u2010temporal lobe surgeries performed with the aid of intraoperative monitoring techniques.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/epd2.70101","type":"journal-article","created":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T10:59:01Z","timestamp":1757156341000},"page":"1217-1226","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Long\u2010term outcomes of epilepsy surgery: A 25\u2010year experience from a tertiary referral center"],"prefix":"10.1002","volume":"27","author":[{"given":"Marco","family":"Almeida","sequence":"first","affiliation":[{"name":"Referral Center for Refractory Epilepsy Epilepsy Surgery Program Group \u2013 ULS Coimbra Coimbra Portugal"},{"name":"European Reference Network EpiCARE Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3962-3080","authenticated-orcid":false,"given":"Francisco","family":"Barros","sequence":"additional","affiliation":[{"name":"Referral Center for Refractory Epilepsy Epilepsy Surgery Program Group \u2013 ULS Coimbra Coimbra Portugal"},{"name":"European Reference Network EpiCARE Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00eas","family":"Cunha","sequence":"additional","affiliation":[{"name":"Referral Center for Refractory Epilepsy Epilepsy Surgery Program Group \u2013 ULS Coimbra Coimbra Portugal"},{"name":"European Reference Network EpiCARE Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Br\u00e1s","sequence":"additional","affiliation":[{"name":"Referral Center for Refractory Epilepsy Epilepsy Surgery Program Group \u2013 ULS Coimbra Coimbra Portugal"},{"name":"European Reference Network EpiCARE Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7206-8667","authenticated-orcid":false,"given":"Rute","family":"Teot\u00f3nio","sequence":"additional","affiliation":[{"name":"Referral Center for Refractory Epilepsy Epilepsy Surgery Program Group \u2013 ULS Coimbra Coimbra Portugal"},{"name":"European Reference Network EpiCARE Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Concei\u00e7\u00e3o","family":"Bento","sequence":"additional","affiliation":[{"name":"Referral Center for Refractory Epilepsy Epilepsy Surgery Program Group \u2013 ULS Coimbra Coimbra Portugal"},{"name":"European Reference Network EpiCARE Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Sales","sequence":"additional","affiliation":[{"name":"Referral Center for Refractory Epilepsy Epilepsy Surgery Program Group \u2013 ULS Coimbra Coimbra Portugal"},{"name":"European Reference Network EpiCARE Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,6]]},"reference":[{"issue":"12","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1111\/epi.14596","article-title":"The epidemiology of drug\u2010resistant epilepsy: a systematic review and meta\u2010analysis","volume":"59","author":"Kalilani L","year":"2018","journal-title":"Epilepsia"},{"issue":"17","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1212\/WNL.0000000000011839","article-title":"Incidence and prevalence of drug\u2010resistant epilepsy: a systematic review and meta\u2010analysis","volume":"96","author":"Sultana B","year":"2021","journal-title":"Neurology"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.seizure.2016.10.015","article-title":"Long\u2010term outcomes of surgical treatment for epilepsy in adults with regard to seizures, antiepileptic drug treatment and employment","volume":"44","author":"Malmgren K","year":"2017","journal-title":"Seizure"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.yebeh.2019.04.037","article-title":"Social functioning of children after epilepsy surgery: a literature review","volume":"96","author":"Braams O","year":"2019","journal-title":"Epilepsy Behav"},{"issue":"5","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1093\/brain\/awh449","article-title":"Long\u2010term seizure outcomes following epilepsy surgery: a systematic review and meta\u2010analysis","volume":"128","author":"T\u00e9llez\u2010Zenteno JF","year":"2005","journal-title":"Brain"},{"issue":"4","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1111\/j.1528-1167.2011.03398.x","article-title":"Impact of epilepsy surgery on seizure control and quality of life: a 26\u2010year follow\u2010up study","volume":"53","author":"Mohammed HS","year":"2012","journal-title":"Epilepsia"},{"key":"e_1_2_9_8_1","first-page":"609","volume-title":"Surgical treatment of the epilepsies","author":"Engel J","year":"1993"},{"issue":"1","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s00401-014-1288-9","article-title":"A neuropathology\u2010based approach to epilepsy surgery in brain tumors and proposal for a new terminology use for long\u2010term epilepsy\u2010associated brain tumors","volume":"128","author":"Blumcke I","year":"2014","journal-title":"Acta Neuropathol"},{"issue":"1","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s40478-020-00904-x","article-title":"Low\u2010grade developmental and epilepsy associated brain tumors: a critical update 2020","volume":"8","author":"Slegers RJ","year":"2020","journal-title":"Acta Neuropathol Commun"},{"issue":"5","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0196274","article-title":"The long\u2010term outcomes of epilepsy surgery","volume":"13","author":"Mohan M","year":"2018","journal-title":"PLoS One"},{"issue":"9800","key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/S0140-6736(11)60890-8","article-title":"The long\u2010term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study","volume":"378","author":"Tisi J","year":"2011","journal-title":"Lancet"},{"issue":"4","key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"513","DOI":"10.3171\/jns.2006.104.4.513","article-title":"Long\u2010term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis","volume":"104","author":"Cohen\u2010Gadol AA","year":"2006","journal-title":"J Neurosurg"},{"issue":"6","key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1136\/jnnp.2006.098244","article-title":"Long term follow\u2010up of the first 70 operated adults in the Goteborg epilepsy surgery series with respect to seizures, psychosocial outcome and use of antiepileptic drugs","volume":"78","author":"Asztely F","year":"2007","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"1","key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1136\/practneurol-2019-002192","article-title":"Epilepsy surgery","volume":"20","author":"Rugg\u2010Gunn F","year":"2020","journal-title":"Pract Neurol"},{"issue":"3","key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1177\/15357597241238898","article-title":"Exit strategy: balancing the risks and rewards of antiseizure medication withdrawal","volume":"24","author":"Galovic M","year":"2024","journal-title":"Epilepsy Curr"},{"key":"e_1_2_9_17_1","article-title":"A review of the epidemiology of temporal lobe epilepsy","volume":"2012","author":"T\u00e9llez\u2010Zenteno JF","year":"2012","journal-title":"Epilepsy Res Treat"},{"key":"e_1_2_9_18_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.yebeh.2021.108221","article-title":"Outcome of epilepsy surgery in lesional epilepsy: experiences from a developing country","volume":"122","author":"Mehvari Habibabadi J","year":"2021","journal-title":"Epilepsy Behav"},{"issue":"3","key":"e_1_2_9_19_1","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1111\/epi.16452","article-title":"Long\u2010term outcomes of reoperations in epilepsy surgery","volume":"61","author":"Yardi R","year":"2020","journal-title":"Epilepsia"},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2020.580221","article-title":"Side of lesions predicts surgical outcomes in patients with drug\u2010resistant temporal lobe epilepsy secondary to focal cortical dysplasia type IIIa","volume":"11","author":"He X","year":"2020","journal-title":"Front Neurol"}],"container-title":["Epileptic Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epd2.70101","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/epd2.70101","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epd2.70101","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:01:27Z","timestamp":1773010887000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/epd2.70101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,6]]},"references-count":19,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/epd2.70101"],"URL":"https:\/\/doi.org\/10.1002\/epd2.70101","archive":["Portico"],"relation":{},"ISSN":["1294-9361","1950-6945"],"issn-type":[{"value":"1294-9361","type":"print"},{"value":"1950-6945","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,6]]},"assertion":[{"value":"2025-05-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}