Surgery for Patients With Epilepsy Is Underused

Conversely, research also shows that patients with normal MRI studies, multifocal seizures, or incomplete resection of the region of seizure onset have a less favorable operative outcome. Age at time of surgery appears to be unrelated to seizure outcome. Thus, older people may be good surgical candidates, he added. But few data about cognitive, psychiatric, and psychosocial issues after surgery are available.

In one study from the University College London, 52% and 47% of 615 patients who underwent surgery for refractory focal epilepsy were seizure free at five and 10 years’ follow-up, respectively. Those with extratemporal resections were twice as likely to have seizure recurrence as those who had anterior temporal lobe resections.

Surgery Versus Medication

“When you compare best pharmaceutical treatment with best surgical practice, the numbers are strongly in favor of surgery, both in terms of efficacy and quality of life, for selected patients,” Dr. Cascino said. In one randomized controlled trial, 80 patients with temporal lobe epilepsy were randomly assigned 1:1 to surgery or optimal medical therapy with AEDs for one year. At one year, 58% of surgical patients were seizure-free versus 8% of the AED group. Quality of life was significantly higher among surgical patients. Four patients had adverse effects of surgery, and one patient in the AED group died.