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March 20, 2012

Early surgery controls seizures, improves quality of life

A new study in the Journal of the American Medical Association finds that the vast majority of patients with previously uncontrolled temporal lobe epilepsy who underwent surgical intervention early in the course of their disease were not only seizure free, but experienced a significantly higher quality of life compared to those who only managed their condition medically. The results demonstrate that, instead of being considered a last resort, early surgery could help epilepsy patients avoid decades of disability.

“The results of this study are very clear: early surgical intervention works, it stops seizures, and it improves quality of life,” says Karl Kieburtz, Robert J. Joynt Professor of Neurology and director of the Medical Center’s Center for Human Experimental Therapy and senior author of the study. “Individuals with temporal lobe epilepsy that is not controlled with medicine should be evaluated for surgical intervention at a comprehensive epilepsy center not after decades of poor response to medicine but within two years. And if they are a surgical candidate, they should give strong consideration to that approach.”

Temporal lobe epilepsy is the most common drug-resistant form of epilepsy. While surgical treatment has been shown to be effective in reducing seizures, the procedure—which is called a temporal lobectomy and entails removing a part of the temporal lobe—is often only considered after all other medical options have failed.

The study—which is called the early randomized surgical epilepsy trial—was designed to evaluate whether early surgical intervention would not only effectively control seizures but also improve quality of life, and whether or not the benefits would be outweighed by side effects of the surgery, such as a decline in cognitive function.

The study found that after two years, 73 percent of the participants who underwent surgery were seizure free in the second year after the procedure as opposed to none in the medical group.

The results were a surprise given that the study had been recommended for early termination due to slow enrollment. The study was originally intended to follow 200 patients, but only 38 were ultimately recruited. Despite the low number of participants, the results are statistically significant enough—in the authors’ opinion—to compel a new approach to the treatment of patients with uncontrolled temporal lobe epilepsy.

“The delay between people becoming refractory and eventually having surgery explored as an option is unacceptable,” said Giuseppe Erba, a neurologist with the Strong Epilepsy Center and a coauthor of the study. “People with temporal lobe epilepsy need to be referred and evaluated for this therapy earlier and before they develop chronic disability.”

Additional coauthors of the study include Michael McDermott, John Langfitt, and Irenita Gardiner with URMC; Jerome Engel, John Stern, Itzhak Fried, and Harry Vinters with the University of California Los Angeles; Scott Mintzer with Jefferson University; and Samuel Wiebe with the University of Calgary. The study was funded by the National Institute of Neurological Disorders and Stroke.

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