Some Patients May Be Surgical Candidates Soon After Failing Drugs
By Salynn Boyles
WebMD Health News
Reviewed by Louise Chang, MD
March 6, 2012 -- Brain surgery is generally considered a last resort for some epilepsy patients whose seizures are not controlled with drugs, but performing surgery earlier may prevent years of suffering, according to a new study in the Journal of the American Medical Association.
Only a small percentage of patients with seizures that can't be controlled by medications are ever referred to an epilepsy center that offers surgery. Those who are referred have often had uncontrolled seizures for several decades.
In the new multi-center study, almost all patients who had surgery much earlier in the course of their disease were seizure-free two years later, while none of the patients who did not have surgery were free of seizures.
The study was small, but researchers say the findings confirm that early surgical intervention offers certain epilepsy patients the best opportunity to avoid a lifetime of disability.
"There is a misconception that epilepsy is not serious enough to warrant brain surgery, but it is," says researcher Jerome Engel Jr., MD, PhD, of the UCLA Seizure Disorder Center. "People die from this disorder. Yet, less than 1% of people with drug-resistant epilepsy are ever referred to epilepsy centers."
Epilepsy Surgery Effective
Nearly 3 million Americans and 50 million people worldwide have epilepsy, and 20% to 40% of them do not achieve seizure control with drugs alone.
In the new study, 38 patients with a form of epilepsy that is often resistant to anti-epileptic drugs were either assigned to continue drug treatments alone or to a treatment regimen that included surgery and drugs.
The surgery involved the removal of an abnormally functioning section of the brain about the size of a walnut, Engel tells WebMD.
During the second year of follow-up, none of the 23 patients treated with drugs alone were free of seizures, but 11 of 15 patients (73%) treated with surgery and drugs were seizure free.
Nine of the surgery patients never experienced another seizure following surgery.
The surgery patients also reported better health-related quality of life for up to 18 months following surgery, but they also had more problems with memory.
Engel says memory and language impairment is an uncommon side effect of the surgery, but many patients who experience this surgical side effect recover fully.
Patients Aren't Being Referred
The researchers originally intended to include 200 patients in the study, but they were unable to recruit this number largely because of a lack of referrals.
The American Academy of Neurology recommends referring certain epilepsy patients who have failed two anti-seizure drugs to specialized epilepsy centers for evaluation.
Neurologist Donald L. Schomer, MD, of Boston's Beth Israel Deaconess Medical Center, tells WebMD this does not happen often enough.
"We see patients all the time who have never been formally evaluated but have been told that they aren't candidates for surgery," he says. "Many of these people have had intractable seizures for eight or 15 or even 20 years."
American Academy of Neurology spokeswoman Sheryl Haut, MD, says the organization has been working with other medical and patient advocacy groups for years to spread the word that patients with intractable seizures need to be evaluated by specialists.
Haut directs the Adult Epilepsy Program at Montefiore Medical Center in Bronx, N.Y.
She says while it is appropriate for patients to be initially treated by a neurologist, those who continue to have seizures while taking drugs should be referred to an epilepsy center.
"Patients who continue to have seizures shouldn't keep taking the same medications year after year," she says.
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SOURCES: Engel, M. Journal of the American Medical Association, March 7, 2012.Jerome Engel Jr., MD, PhD, Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, Calif.Sheryl Haut, MD, MD, director, Adult Epilepsy Program Montefiore Medical Center, Bronx, N.Y.; spokesperson, American Academy of Neurology.Donald L. Schomer, MD, professor of Neurology, head, Division of Epilepsy, Beth Israel Deaconess Medical Center, Boston, Mass.News release,UCLA Health Sciences.News release, JAMA.Epilepsy Foundation.
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