From Our 2008 Archives

Surgery a Boon for Most Common Form of Epilepsy

By Amanda Gardner
HealthDay Reporter

TUESDAY, Dec. 2 (HealthDay News) -- People with the most common form of epilepsy who don't respond to drugs would gain about five years of life, and dramatically improved quality of life at that, if they had a certain form of brain surgery.

That's the finding of a new study that relied on computer modeling to assess the benefits of surgery of the temporal lobe region for people with temporal lobe epilepsy.

"In light of what we found, some patients with this type of epilepsy, whose seizures are not controlled with medication, should consider getting further evaluation to see if they would be eligible for a procedure at a specialized epilepsy center," said study author Dr. Hyunmi Choi, an assistant professor of clinical neurology at Columbia University Medical Center in New York City.

And doctors perhaps should not wait to exhaust all medication options before considering surgery, Choi added.

"There are some physicians who just continue trying different medications, not realizing that there is a small surgical complication rate. But the chances of becoming seizure-free with this procedure is so much higher," Choi noted.

One expert agreed that the surgery should considered more often.

"The increased survival of five years is really a significant benefit. That's really a dramatic number," said Dr. Michel Berg, a neurologist and medical director of the Strong Epilepsy Center at the University of Rochester Medical Center, in Rochester, N.Y.

"People have been aware of the benefit of temporal lobe epilepsy surgery and the substantially greater portion of people that end up seizure-free, which substantially improves quality of life. Then, in addition to that, [there] is a survival benefit, which is just an additional piece of information that further emphasizes that we should be offering this treatment option to people with medically refractory temporal lobe epilepsy as early as possible," added Berg, who was not involved with the study

The findings were published in the Dec. 3 issue of the Journal of the American Medical Association.

An estimated 20% to 40% of people with epilepsy do not respond to drugs, and are more likely to die early than people who do benefit from medication.

Yet despite scientific evidence and a statement from the American Academy of Neurology that temporal lobe surgery reduces seizures (two-thirds of patients become seizure-free) and improves quality of life, such surgery appears to be greatly underused.

According to an editorial in the same issue of the journal, an estimated 100,000 patients in the United States alone could be candidates for surgical treatment, but less than 2,000 actually had such a procedure in 1990.

What's more, those who do have surgery are often referred late, after an average of 20 years of illness. This delay may result from difficulty in diagnosing tough cases early enough. And new drug treatments may actually have lengthened the time to surgery, the editorial stated.

Temporal lobe epilepsy (when seizures come from the temporal lobe region of the brain) is the most common form of epilepsy, and the most amenable to surgery.

For the new study, the researchers used the "Monte Carlo" computer simulation model, which evaluated information on possible surgical complications, quality-of-life information, and patients' seizure status.

Surgery was the preferred treatment in almost 100% of the simulations, increasing survival by five years. When considering quality-adjusted life years (QALYs), surgery was preferred 96.5% of the time and increased QALYs by 7.5 years. Patients, who were an average of 35 years old, would gain 15 more years without seizures, the study found.

The benefits are likely understated, according to the editorial, by Dr. Jerome Engel Jr., a neurologist at the David Geffen School of Medicine at the University of California, Los Angeles. The reason: The model patient used in this study was 35 years old, and many people could benefit from surgery much earlier.

SOURCES: Hyunmi Choi, M.D., assistant professor, clinical neurology, Columbia University Medical Center, New York City; Michel Berg, M.D., neurologist and medical director, Strong Epilepsy Center, University of Rochester Medical Center, Rochester, N.Y.; Dec. 3, 2008, Journal of the American Medical Association

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