Surgery for Patients With Epilepsy Is Underused

Another randomized trial compared early referral to surgery of patients with drug-resistant mesial temporal lobe epilepsy with continued AED treatment for controlling seizures and improving quality of life. Although the study was halted prematurely due to slow accrual, none of the 23 patients in the AED group were seizure-free during year two of follow-up versus 11 of 15 surgery patients. Surgery had a significantly favorable treatment effect on quality of life. One person in the surgery group had a transient neurologic deficit attributed to postoperative stroke, and three participants in the medication group had status epilepticus.

Surgery in Patients With Normal MRI

One study followed 87 consecutive patients with normal MRI for one year after epilepsy surgery. “They all had temporal lobe epilepsy. Most of them had nonspecific gliosis, a few met the criteria for mesial temporal sclerosis, and none of them had tumors or lesions,” Dr. Cascino said. “About 55% were seizure-free, which compares quite favorably with neuromodulation and other treatments.” The best predictor of seizure freedom was unilateral interictal epileptiform discharge (IED) on scalp EEG and complete resection of brain regions generating IEDs on baseline intraoperative electrocorticography.

Another study demonstrated that the addition of PET to the diagnostic workup may improve outcomes. Among adults with PET-positive and MRI-negative temporal lobe epilepsy, three out of four were seizure-free postoperatively.