Brain surgery for epilepsy underutilized

Ten years ago, a landmark clinical trial in Canada demonstrated the unequivocal effectiveness of brain surgeries for treating uncontrolled epilepsy, but since then the procedure has not been widely adopted - in fact, it is dramatically underutilized according to a new study from the University of California, San Francisco (UCSF).

The study, published this month in the journal Neurology, showed that the number of Americans having the surgery has not changed in the decade since release of the effectiveness study, though surgical treatment is now uniformly encouraged by neurology and neurosurgery professional societies.

The U.S. Centers for Disease Control and Prevention estimates that 2 million Americans have epilepsy. Hundreds of thousands of these men, women and children suffer from uncontrolled seizures, but nationally only a few hundred are treated surgically each year with UCSF performing about 50 of the operations.

Among people who do have the operation, the study found, there are significant disparities by race and insurance status. White patients were more likely to have surgery than racial minorities, and privately insured patients were more likely to undergo surgery than those with Medicaid or Medicare.

"As a medical community, we are not practicing evidence-based medicine with regard to the treatment of patients who have epilepsy," said Edward Chang, MD, chief of adult epilepsy surgery in the UCSF Department of Neurological Surgery and the UCSF Epilepsy Center. "There are a lot of people who are taking medications and continuing to have seizures even though they can potentially be seizure-free."

A MODERN SURGERY FOR AN ANCIENT DISEASE

Epilepsy has been recognized as an important neurological condition since ancient times and its name means "seizures" in Greek. It can be inherited or it can be caused by anything that injures or irritates the brain. Hippocrates, the father of western medicine, described it in detail in his writings some 2,500 years ago, and it is believed to have afflicted many famous people throughout history, including Julius Caesar.

Cases 1 I actually had a very good experience considering that I had four seizures the day before my surgery (Dec. 5, 1994) and haven't had another since. However, the recovery was somewhat tough because I didn't really know what to expect and I worried way too much about the possibility of having another seizure and how I would react should one have happened.

In retrospect, I'd have to say that I should have opened up more during the recovery process rather than held things inside of me. I simply didn't want to be a bother to anyone and that philosophy was a mistake. Brain surgery is a very big deal and I think what weighs on a patient's mind is that you can't see it; you can't feel it and you really can't treat it following the procedure. That said, it's such a mysterious experience and I discovered the hard way that while I would generally wake up feeling well, it didn't take much time before I would start to get tired. However, rather than taking a break and maybe even lying down for awhile, I'd keep pushing things until I was literally exhausted.