People with epilepsy whose seizures cannot be relieved with drug treatment could undergo surgery to remove the area of the brain that is causing the problem. If such patients are seizure-free 12 months after surgery, they're likely to remain so for the long term, a recent study suggests.
Researchers from the Yale University School of Medicine in New Haven, USA, followed up 175 epilepsy patients who underwent brain surgery between 1972 and 1992, for an average of 8 years.
It was found that nearly two-thirds of the patients did not have a relapse during the first year after surgery. Even among the 65 patients who did have a relapse, half had one or fewer seizures per year. According to the researchers, the longer the seizure-free period, the less severe the relapse. Although not everyone remained free of seizures (after surgery), even those who relapsed usually had very few seizures as compared to the multiple seizures every month before the surgery. The researchers also found that the duration for which the patients had epilepsy (before surgery) predicted how well surgery worked. Although a longer duration of epilepsy before the surgery predicted relapse, all the patients in this sample had a very long duration of epilepsy, an average of 16 years in the seizure-free patients vs. 20 years in the ones who had a relapse.
Traditionally, physicians, including neurologists, have considered epilepsy surgery the last treatment option. However, the researchers suggest that surgery should be considered more readily for epilepsy patients after they've shown no benefit from two anti-seizure drugs.
Neurology, Aug 2003