Early surgery may help prevent medicine-resistance

Published: May 31 2022
Last updated: May 12 2023

Epilepsy surgery is a successful treatment, especially in people with focal epilepsy which is not medicine-resistant, according to a recent study from Italy published in Epilepsy & Behavior Reports.

Researchers Veronica Pelliccia and colleagues explained that epilepsy surgery is typically offered to people with epilepsy where medicines have not worked (medicine-resistant epilepsy).

But the authors suggested that this treatment can also benefit people with epilepsy that is not medicine-resistant. They said that if offered earlier, especially in children, surgery can be more successful and could prevent some people’s epilepsies from becoming medicine-resistant.

The researchers wanted to find out whether the outcomes of surgery are different depending on whether people with epilepsy have become resistant to medicines or not.

They studied 250 people with focal epilepsy who had at least 3 months of seizure freedom after starting treatment with medicine. The participants were split into two groups. One group comprised those who had epilepsy surgery during the period of seizure freedom (74 people).The other included those who had surgery later, when their seizures had returned and their epilepsy had become resistant to medicines (176 people).

Almost everyone (95.9%) in the group who had surgery during the period of seizure freedom stayed seizure free, and the rest had only focal aware seizures for at least two years after surgery. In the group who had become medicine-resistant, this was the case in just over three-quarters of people (77.3%). Also more than four in five people (83.8%) in the group who had early surgery were able to come off their epilepsy medicines after surgery. In the group with medicine-resistant epilepsy, this was around half (49.4%).

The researchers concluded that epilepsy surgery should be considered earlier and may help prevent epilepsy becoming medicine-resistant in some people. This echoes the updated guidelines on epilepsy by the National Institute for Health and Care Excellence (NICE). The guidelines say people with epilepsy that is not medicine-resistant should be referred for surgery assessment if an MRI shows a high risk of their epilepsy becoming medicine-resistant.

The full research is available online.