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Epilepsy Type More Common than Suspected, Curable with Surgery
ST. PAUL, MN (November 20, 1998) - A type of epilepsy that does not respond well to medication but is curable with surgery is more common than physicians suspected, according to a study and accompanying editorial in the November issue of Neurology, the scientific journal of the American Academy of Neurology.
This type of epilepsy, called mesial temporal lobe epilepsy, is caused by an abnormality in the brain's hippocampus. Eighty to 90 percent of patients with this disorder will become seizure free after surgery, said UCLA neurologist Jerome Engel Jr., MD, PhD, who wrote the editorial about the study.
"This study shows that this is a very common form of epilepsy," Engel said. "Only 1,000 to 2,000 surgeries are performed in the United States each year for this condition. If it is as common as the study suggests, then many tens of thousands of people could benefit from this surgery."
The study showed that seizures caused by this type of epilepsy are more likely to reoccur and are more resistant to drugs than seizures due to other causes.
"With the new technology in neuroimaging, we can identify these patients very easily without using expensive or risky procedures," said Engel. "And we don't have to try different drug regimens that won't work effectively anyway."
The seizures and their effects on the patient become more severe over time with this epilepsy.
"Early surgical intervention may prevent irreversible disability," Engel said. "Uncontrolled seizures can lead to psychological and social consequences due to the inability to drive, perform adequately in school, gain useful employment or have meaningful relationships because of the direct effect of the seizures or the stigma associated with them."
The study involved 2,200 patients referred to an epilepsy center in Paris, France, over seven years. Most of the patients had severe epilepsy, or seizures difficult to control with drugs. Magnetic resonance imaging (MRI) was used to identify any brain abnormalities causing the seizures. Brain abnormalities in the hippocampus were detected in 282 people.
The 282 people with mesial temporal lobe epilepsy had the worst response to medication. In general, about 80 percent of epilepsy patients will become seizure free on medication; only 11 percent of those with hippocampal abnormalities were free of seizures for more than a year. About 50 percent of patients with brain abnormalities due to a stroke or tumor were seizure free for more than a year.
Engel said the condition should be recognized early. "Virtually all patients with seizures that are not controlled by two or three of the most common epilepsy drugs should undergo high resolution MRI evaluations looking for this abnormality," he said.
"These findings could have a profound impact, not only on the lives of individual patients, but also on society," Engel said. "For relatively inexpensive diagnostic tests and a surgical procedure, patients who otherwise would face a lifetime on welfare and consume a considerable amount of health care resources could instead be cured and returned to the workforce as full-fledged tax-paying citizens."
Engel said that managed care can place a hurdle in this process by denying coverage for the initial testing and the surgery. "Many HMOs drag their feet and hope if they can delay this long enough, it will become someone else's problem," he said. "But these patients can't afford to wait."
This is the first study to examine how the cause of epilepsy affects seizure reoccurrence and medication effectiveness, according to Paris neurologist and study author Franck Semah, MD.
"Our study shows that we need to look for the cause of the epilepsy before treating patients," Semah said. "We hope that in the future more specific treatments, including surgery, will be developed based on the cause of the epilepsy."
Epilepsy affects about 2.5 million Americans. The American Academy of Neurology is an association of more than 15,000 neurologists and neuroscience professionals.
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