Brain surgery for epilepsy holds up long-term

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After temporal lobectomy for epilepsy, half of patients are seizure free 30 years later, according to a study from the National Institute of Neurological Disorders and Stroke in Bethesda, Maryland. Modern procedures are probably even better.

Temporal lobectomy involves surgical removal of the temporal lobe of a cerebral hemisphere to eliminate the focus of electrical activity that triggers epileptic Seizures.

Dr. William H. Theodore and Kathy Kelley identified 48 patients who underwent temporal lobectomy between 1965 and 1974.

As they report in medical journal Neurology, 27 patients were seizure free or experienced only non-disabling auras one year after surgery. Thirty-two had at least one postoperative seizure at some point. The investigators found that some patients had a fluctuating course, with 15 percent experiencing a change in seizure control over periods of as long as a decade.

As noted, 50 percent were seizure free after an average follow-up of 29.9 years. Ten had died, but only three deaths were a direct result of epilepsy.

Current surgical treatment of epilepsy is likely to result in even better outcomes, Theodore told Reuters Health.

“There have been technical improvements, as surgeons have tried to see what minimum amount of brain tissue needs to be removed in order get a good result,” he noted. “And today there are better means of localizing where seizures are coming from, particularly when using neuroimaging such as MRI and PET scans.”

He said that many patients wait far to long - years or decades - before deciding to have surgery.

“Currently we recommend that surgery be considered for patients who have focal epilepsy if they have not responded to at least two antiepilepsy drugs given in good doses for several months,” he advised.

“If we can stop seizures during people’s adolescence then that’s a tremendous advantage for them,” he added.

SOURCE: Neurology, June 14, 2005.

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