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"Epilepsy surgery may be successful despite post-op seizures" - research

20 April, 2005

A study led by researchers at Jefferson Medical College
has found that patients who had an initial seizure within the first
four months of epilepsy surgery were less likely to do as well in the
long term as those individuals who did not.

The research, presented to the annual meeting of the American Academy of Neurology,
monitored 387 people with epilepsy who had surgery. Although about
two-thirds of the group experienced at least one seizure some time
after surgery, a similar percentage ultimately stopped having seizures.

The
patients monitored were categorised according to how soon (or if) they
had a first seizure after their surgery and how successful the surgery
was in stopping or reducing the number of seizures they had.

Daniel Parish, a second-year medical student at Jefferson, was the lead author of the report. He said:

"A
patient has surgery to remove some brain tissue, hoping to cure his
epilepsy, and has a seizure a week or a month or a year later, and
wonders, 'What does this mean? Has surgery failed?'. We wanted to know
if the timing of seizures after surgery was related to long-term
outcome.

The
study concluded that having the first seizure within the first four
months was a good indication that the surgery may not have been
effective.

Mr Parish continued:

"If
the person had his first seizure in say two months post-surgery, there
is a reduced chance he will remain free of seizures for the long term.
If someone doesn't have the first seizure until six months, chances are
that person may have a seizure or two, but ultimately will become
seizure-free. The longer a person is seizure-free after surgery, the
better.

"If
not enough tissue was taken out, it is going to happen sooner rather
than later. There is also a known 'running down' phenomenon in which in
some cases the brain eventually loses the ability to have seizures.

Professor Michael Sperling, professor of neurology at Jefferson, commented:

"While
seizures in the first few months indicate a worse prognosis, many
patients still do well in the long run. Experiencing a seizure after
surgery doesn't mean that surgery wasn't successful. However, early
seizures might prompt physicians to do additional testing and consider
further surgery.'

The
researchers plan to further analyse the results and break down the
various seizures types to see if that is relevant when seeing how well
people do.