More than two million people in the United States (about 1 in 100) have experienced a seizure or have been diagnosed with epilepsy according to the National Institute of Neurological Disorders and Stroke. For about 80 percent of those diagnosed with epilepsy, seizures can be controlled with medications and surgery. Epilepsy was the focus of an important study published about one year ago in the August 2, 2001, issue of The New England Journal of Medicine, "A Randomized, Controlled, Trial of Surgery for Temporal-Lobe Epilepsy," tested the effectiveness of medication versus surgery for the treatment of epilepsy. Authors of the study including Samuel Wiebe, MD; Warren Blume, MD; John Girvin, MD, PhD, and Michael Eliasziw, PhD, determined that for temporal-lobe epilepsy, surgery is more effective than antiepileptic medications.
"Seizures in temporal-lobe epilepsy, which often start in childhood in otherwise healthy persons, occur both as simple partial seizures with some awareness of self and surroundings, and as disabling complex partial seizures in which awareness is impaired," said Howard Weiner, MD, a member of the American Association of Neurological Surgeons. "Surgery as a treatment option for temporal-lobe epilepsy may not only control seizures but also can prevent untimely death."
The study, conducted between July of 1996 and August of 2000 at the London Health Sciences Centre, University of Western Ontario, Canada, compared medical treatment with surgical treatment for patients with temporal-lobe epilepsy. Of 92 patients screened, 86 were eligible; 80 agreed to participate in the study.
The 80 patients were randomly assigned to a surgical group (40 patients) or to a medical group that was treated with antiepileptic drugs for one year (40 patients). The patients in the surgical group underwent surgery within four weeks if they were deemed eligible. After surgery, they received optimal medical therapy for one year. Patients assigned to medical treatment were placed on a one-year waiting list for admission to the epilepsy monitoring unit.
All 80 patients received similar psychiatric or psychological treatment, as determined by the treating epileptologist and psychologist. Patients wrote detailed descriptions of all seizure-like events in monthly seizure diaries (3, 6, 9, and 12 months).
Patients in the surgical group had fewer seizures that impaired awareness and a significantly better quality of life than the patients in the medical group. Four patients had adverse effects from surgery. In the medical group, one patient died. At one year, 23 of the 36 patients who underwent surgery (64 percent) were free of seizures that impaired awareness, and 15 of these patients (42 percent) were free of all seizures.
"The study's results support the benefits of surgery over medical therapy in terms of the control of seizures, the quality of life, and the rates of employment and school attendance among patients with poorly controlled temporal-lobe epilepsy," said Dr. Weiner. "The absolute benefit of surgery in terms of the rate of freedom from seizures was significant and precise."
In summary, this study reveals that prolonged trials of anticonvulsant drugs prove ineffective and supports the notion that patients with temporal-lobe epilepsy should be evaluated for surgery in order to avoid unexpected disability and perhaps even death. However, the study does not address the question of the optimal timing for surgery, particularly whether early surgery for temporal-lobe epilepsy is more effective than medical therapy.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with nearly 5,500 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are Board-certified by the American Board of Neurological Surgery. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.
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