Epilepsy surgery improves lives

The vast majority of epilepsy patients who have brain surgery to treat the seizure disorder find it improves their mood and their ability to work and drive, a new study reveals. 

A second study also indicates the procedure is safe and effective for patients over 60.

"They're both reassuring findings," said Bruce Hermann, director of the Charles Matthews Neuropsychology Lab at the University of Wisconsin School of Medicine and Public Health.

 "Epilepsy is a difficult disorder to have and live with, coming with a high rate of depression and affecting the ability to drive and work.

"We always hoped surgery would have positive effects on patients' life situations, and this research does show that, and shows that the outcomes persist," added Hermann, who was not involved with the research.

Positive outcomes

Affecting about 2.2 million Americans and 65 million people globally, epilepsy is a seizure disorder triggered by abnormal nerve cell signalling in the brain, according to the Epilepsy Foundation.

More than 1 million Americans with epilepsy suffer from treatment-resistant seizures that can hamper their ability to drive, work and learn. Epilepsy is the third most common neurological disorder, after Alzheimer's disease and stroke.

Researchers from Henry Ford Hospital in Detroit, conducting phone interviews with more than 250 epilepsy patients who had brain surgery there between 1993 and 2011, found that 92% considered the surgical treatment worthwhile. More than three-quarters of those undergoing surgery on their brain's temporal lobe the most common site to remove brain tissue triggering seizures were later seizure-free or experienced only rare disabling seizures.

About half of the patients reported being able to drive at the time they were interviewed, compared to 35% who were able to do so before surgery. Those with favourable surgical outcomes also were more likely to be working and less likely to be taking antidepressants, the investigators found.

"It was very encouraging to document the patients' perspective about the value of surgery," said study co-author Dr Marianna Spanaki, director of the epilepsy monitoring unit at Henry Ford Hospital. "If presurgical evaluation is delayed, people with epilepsy suffer from ongoing medication and seizure side effects that compromise their quality of life."

Second study 

The second study, by researchers at University of California, Los Angeles, found that 90% of epilepsy patients aged 60 and older undergoing brain surgery experienced good outcomes, with 70% of them becoming seizure-free. The study authors said the data demonstrates that older age alone shouldn't necessarily block consideration of epilepsy surgery.

Between 100 000 and 200 000 epilepsy patients in the United States are candidates for epilepsy surgery, which is typically, considered when seizures continue despite the use of several types of anti-seizure drugs, Spanaki explained.

Patients undergo a pre-surgical workup that provokes seizures under close observation and determines which part of the brain generates seizures and can be safely removed.

While vision problems occur in a small number of epilepsy surgical patients, she said, major complications are rare. Private insurance plans and Medicare typically cover all expenses associated with the procedure, Spanaki said.

"There's a misconception that the more anti-seizure drugs people with epilepsy try, the better chances they have to achieve seizure freedom or reduction," she said. "This notion delays referrals for pre-surgical evaluation."

Hermann added: "In general, it's better to consider epilepsy surgery sooner rather than later."

More information

The Epilepsy Foundation offers more information about epilepsy.


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