Surgery may be effective in difficult-to-treat epilepsy cases

By Dr. Ananya Mandal, MDOct 17 2011

Researchers claim that for those epilepsy cases that have proved difficult to control, surgery may be the answer.

A study published this week in the journal the Lancet involved 615 patients who were suffering from refractory focal epilepsy, a type that has proved difficult to treat, even with multiple medications.

Results revealed that 52% of patients who underwent surgery for the condition remained free of seizures five years after undergoing surgery, and 47% of them remained seizure-free 10 years later. Additionally, none of the patients experienced a worsening of seizures following surgery. Many patients remained on anti-seizure drugs.

The longer a person was seizure free, the less likely they were to relapse say researchers John S. Duncan and colleagues. For patients who have exhausted other options in treating their epilepsy, such surgery “is appealing,” the authors write.

“These days if a patient has failed two or three medications we might consider surgery because it has become much safer and more effective over the last few decades,” Ashesh Mehta, director of epilepsy surgery at the North Shore-LIJ Health System Comprehensive Epilepsy Care Institute in New Hyde Park, N.Y. Of the 2 million Americans with epilepsy, about two-thirds of adults achieve good seizure control with drug treatments, Mehta continued. “The rest have seizures that do not respond to drugs, and these are the patients who could benefit the most from surgical treatment,” he said.

Once considered a last resort for patients with few treatment options, the researchers conclude that patients whose seizures are not controlled with drugs may benefit from surgery earlier in the course of their disease. “Surgery is successful for many individuals in whom anti-epileptic drugs have not been effective, but further improvements need to be made to pre-surgical assessment to further increase rates of success,” the researchers write. However surgery cannot cure all cases they warn since only 28% of seizure-free individuals had stopped taking medications as of their most recent checkup.