Epilepsy Surgery Effective at Controlling Seizures Over Long Term

Epilepsy surgery shows promise for long-term control of seizures, says study.

Oct. 14, 2011— -- Epilepsy sufferers living with a certain form of the disease may find hope in a new study that found surgery is effective at stopping seizures that can't be controlled by medication.

The study, published in next week's edition of The Lancet, evaluated the outcome of epilepsy surgery for 615 adults with refractory epilepsy, the type that can't be controlled by medication. Researchers led by Jane de Tisi of University College London found that 52 percent of patients were free of major seizures five years after surgery and 47 percent were free of them 10 years after surgery. About 30 percent of the study participants no longer needed any medication to control seizures.

Patients who had temporal lobe surgery were less likely to experience a recurrence of seizures than patients who had procedures in other parts of the brain.

Patients Should Be Referred for Surgery Sooner

Neurologists not involved in the research said the study is one of the only ones that followed patients for that long a period of time. It is important work, they added, because it highlights how effective surgery can be for adults and children with medically refractory epilepsy.

Although they believe the surgery is effective in controlling seizures, many seizure patients don't elect to have an operation. Some study patients lived with their uncontrolled seizures for more than 20 years.

"Surgery has been used for quite some time now, and it takes way too long for people to come have surgery," said Dr. Christine Bower Baca, assistant professor of neurology at UCLA's Geffen School of Medicine.

"Epilepsy surgery is a very appropriate option to look at once a patient has been deemed medically refractory, and neurologists should be referring more than they are," said Dr. Brien Smith, chair of the board of directors of the Epilepsy Foundation. "There is some argument that epilepsy surgery is one of the most underutilized procedures in the U.S."

In a comment accompanying the study, Drs. Ahmed-Ramadan Sadek and William Peter Gray of Southampton University Hospitals wrote that while the research validates epilepsy surgery as an effective treatment option that's been used for the past two decades, the process still needs improvement.

They added that there should be a better way to identify which patients will benefit from surgery, and there should be improvements in the surgery itself that will lead to better success rates.

Although many of the study patients no longer needed antiepileptic medications, a number of them chose to stay on them.

"Coming off meds can be inconvenient," said Baca. "It involves no driving in order to test whether they are still seizure-free."

Being seizure-free, Baca added, could mean drastic improvement in the lives of many seizure patients.

"Seizures impact a person's life in many ways," she said. "They often have difficulties with employment and education. They can't drive. So a treatment that can finally control seizures is really important to consider."

Living with the frequent, unpredictable seizures caused by epilepsy is something 23-year-old Tina Westra of Herndon, Va., has spent much of her life doing.

"I had grand mal seizures probably about once a month in high school," Westra said. "And in college, I started having them a lot more frequently, sometimes three a day."

She got those seizures under control with medication, but now suffers from juvenile myoclonic seizures, which consist of little jerks of the arms, shoulders or legs. Each one lasts about one second, and she gets them a couple of times a week.

Living with the seizures means she has to be extra careful when handling fragile items like dishes, and it also means relying on a number of different medications.

"I joke that I carry my home pharmacy everywhere I go," Westra said. "If I'm out in public, I'm very cautious because I look like I'm a drug dealer when I pull out my pharmacy."

Westra's type of epilepsy is normally controlled with medication and is not treated with surgery, but she still hopes surgery will become more of a treatment mainstay so others can benefit.

"I think about younger kids who have seizures. I would want them to be able to live the most normal life possible," she said.