Epilepsy Surgery Demonstrates Long Term Positive Results

A new study has found that neurosurgery for refractory focal epilepsy leaves half of the adults treated free of seizures for up to 10 years.

Researchers at University College London (UCL; United Kingdom) conducted a prospective cohort study of the long-term outcome of surgery for epilepsy in 615 adults (497 anterior temporal resections, 40 temporal lesionectomies, 40 extratemporal lesionectomies, 20 extratemporal resections, 11 hemispherectomies, and seven palliative procedures), with prospective annual follow-up for a median of eight years. The researchers used Kaplan-Meier survival analysis to estimate time to first seizure, and investigated patterns of seizure outcome.

The results showed that an estimated 52% of patients remained seizure free--apart from simple partial seizures (SPS)--at five years after surgery, and 47% at 10 years. Patients who had extratemporal resections were more likely to have seizure recurrence than were those who had anterior temporal resections, whereas for those having lesionectomies, no difference from anterior lobe resection was recorded. Those with SPS in the first two years after temporal lobe surgery had a greater chance of subsequent seizures with impaired awareness than did those with no SPS. Relapse was less likely the longer a person was seizure free and, conversely, remission was less likely the longer seizures continued. The study was published in the October 15, 2011, issue of the Lancet.

“Neurosurgical treatment is appealing for selected people with refractory focal epilepsy,” concluded senior author John Duncan, MD, and colleagues of the UCL Institute of Neurology. “Our data provide realistic expectations and indicate the scope for further improvements in presurgical assessment and surgical treatment of people with chronic epilepsy.”

First line therapy for epilepsy involves treatment with anticonvulsive drugs, and most patients will respond to one or two different medication trials. However, in up to one third of patients with epilepsy, medication alone fails to eliminate seizures, and can also cause unacceptable adverse effects. In these patients, workup for the feasibility of epilepsy surgery should be considered, using a neurosurgical procedure in which the focal area of the brain involved in the seizures is either resected, disconnected, or is stimulated. The goal is to eliminate seizures or significantly reduce seizure burden.

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