Аннотация
Background and Objectives: Evidence on epilepsy surgery from Central Asia is limited, reflecting the real-world challenges of developing this service in low- and middle-income settings. We evaluated one-year seizure outcomes after resective surgery for drug-resistant focal epilepsy at a single center in Kazakhstan, and we assessed whether the use of advanced presurgical imaging was associated with seizure freedom. Materials and Methods: A retrospective cohort study was conducted, including consecutive adults who underwent curative-intent resective epilepsy surgery from 2017 to 2023. Outcomes at 12 months or more post-surgery were classified using the Engel criteria. Logistic regression was used to examine associations between the advanced presurgical diagnostic tool and achieving an Engel class I outcome. Crude and adjusted risk ratios (RRs) for not achieving Engel I were estimated using modified Poisson regression with robust SEs. Results: Among 112 patients (median age 31 years; median epilepsy duration 19 years), 76% underwent temporal lobe procedures and 71% had lobectomies. At one year, 74 patients were seizure-free (Engel II: 15.2%, III: 11.6%, IV: 7.1%). Year-to-year Engel I rates varied without a significant linear trend from 2018 to 2023. In bivariable analyses, MRI-defined atrophy (RR, 3.14) and mixed lesions (RR, 2.62) were associated with a higher risk of not achieving Engel I, whereas longer epilepsy duration was linked to a lower risk (RR, 0.97 per year). In adjusted models, predictors of not achieving Engel I included generalized tonic–clonic seizures (aRR, 1.96), atrophy (aRR, 2.98), mixed lesions (aRR, 2.45), and undergoing any advanced diagnostic test (aRR, 3.38). Longer epilepsy durations remained protective (aRR 0.95 per year). In modality-specific logistic models, fMRI use was associated with higher odds of Engel I (aOR 3.39), and MR spectroscopy was associated with lower odds (aOR 0.33). Conclusions: In this Central Asian single-center cohort, about two-thirds of adults achieved complete seizure freedom one year after resective surgery—comparable to international benchmarks. Advanced imaging modalities showed divergent associations with outcomes, likely reflecting confounding by indication. These findings support the feasibility of effective epilepsy surgery in a low-resource context and the value of targeted use of advanced imaging.