Brain Surgery Touted for Epilepsy

In a new study, researchers say brain surgery for a common type of epilepsy is seven times as effective as drug regimens currently used.

The disorder, characterized by seizures so severe that they interfere with an affected individual's awareness of his or her surroundings, affects about 2 million Americans. The condition is most often treated with antiepileptic drugs, but lead author Samuel Wiebe, M.D., associate professor of clinical medicine at the University of Western Ontario, says surgery is a better option.

"Epilepsy surgery is a vastly superior medical treatment and should not be seen as a last resort," Wiebe said. "Up until now there has been no scientifically strong evidence to support epilepsy surgery, and therefore I guess people doubted the effectiveness of the surgery."

There Are Side Effects

The study, published in this week's issue of the New England Journal of Medicine, represents the first ever clinical trial comparing the effectiveness of surgery for epilepsy vs. that of treatment with medicine. Eighty epilepsy patients were randomly assigned to receive one of two treatments. Forty received surgery, while the remaining 40 were treated with the standard therapy of drugs.

During the surgical procedure, a 4- to 6-centimeter (about 2-inch) slice of the patient's brain is taken from the temporal lobe, which is responsible for memory and language. Fifty-eight percent of the patients in the study who had the surgery were free of the most severe types of seizures after one year, compared to only 8 percent among the group treated with drugs.

And 38 percent of patients receiving surgery were free of all seizures.

The surgery is not without its side effects. Wiebe said two patients who underwent surgery experienced short-term memory problems and difficulty learning new material. And Martin Weiss, M.D., chairman of the USC Department of Neurological Surgery, said procedures involving the temporal lobe can have lasting consequences.

"Even though I am a surgeon and we do these at our center, the procedure is not entirely benign," Weiss said. "There is evidence that resection of the temporal lobe can influence IQ scores negatively."

Benefits Touted

But Wiebe said his study shows the benefits of the procedure far outweigh the risks.

"There has been a perception that brain surgery is dangerous and it should only be used as a last resort," Wiebe said. "But we've shown that it is actually very safe. We looked very carefully for side effects, like poor function, and what we found was that overall there were no problems."

Aside from showing the benefits of epilepsy surgery, the study is also unusual in that it involves a clinical trial of a surgical procedure for human patients. Patients who chose to be part of the study were randomly picked to either receive the normal course of drugs or the brain surgery.

"Those who were randomized for surgery got immediate admission," he said. "That was one of the major aspects that allowed us to be able to do this trial.

"Now that this first randomized trial has been done, I believe people will be much more open to randomized control studies in other areas of epilepsy treatment."

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