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The Cutting Edge

Epilepsy Surgery: Not Treatment of Last Resort

For people with a particular form of epilepsy, surgical intervention can literally be life-restoring. Yet, only a small fraction of patients who suffer from what's known as medically intractable epilepsy, in which seizures are resistant to drugs, will seek surgery, seeing it as a last resort.

But a multi-center study led by researchers at UCLA shows that for people suffering from intractable temporal lobe epilepsy, the most common form of intractable epilepsy, early surgical intervention followed by antiepileptic drugs stopped their seizures, improved their quality of life and helped them avoid decades of disability.

The report was published in the Journal of the American Medical Association. "In short, they got their lives back," says Jerome Engel Jr., M.D., Ph.D., director of the UCLA Seizure Disorder Center.

For the study, 16 epilepsy centers nationwide recruited 38 individuals suffering from intractable mesial temporal lobe epilepsy. Fifteen participants underwent surgery and 23 were assigned to a program of best medical care. The researchers found that after two years, 85 percent of the participants who underwent surgery were seizure-free in the second year after the procedure; by comparison, none in the medical-care group were seizure-free.

The surgical group also reported a significantly higher quality of life, a significant increase in independence, and an improved willingness and ability to socialize with friends and family. The number of individuals who reported being able to drive a car rose from 7 percent to 80 percent in the surgical group at the end of two years. Cognitive problems such as memory loss were similar in both groups.

"The results of this study are very encouraging," Dr. Engel says. "Surgical treatment for temporal lobe epilepsy soon after the failure of two trials of anti-epileptic drugs stops seizures and improves quality of life. Continuing anti-epileptic drug treatment alone does not. So the message is clear: Early surgery, before the adverse social and psychological consequences of seizures become irreversible, offers the best opportunity to avoid a lifetime of disability."


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