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Long-term outcome of epilepsy surgery is "favourable"

26 August, 2003

The majority of epilepsy
patients who are seizure-free for the first year after surgery will
have a favourable long-term outcome, according
to a study published in the journal Neurology.

The
study examined 175 patients with difficult-to-control epilepsy
who had surgery
that removed
the region of the brain involved in seizure
generation and who were seizure-free for the first year following surgery.

Researchers followed up with the patients for an average of more than
eight years, and found that 63 per cent stayed seizure-free.

Among the 65 patients who relapsed, 51 per cent had one or fewer seizures
per year. A longer seizure-free period indicated that a relapse would
be less severe. The remaining patients had more than one seizure per
year, and 10 of these patients, who relapsed within four years of surgery,
had more than one seizure per month.

Duration of epilepsy before surgery - rather than age at the onset of
epilepsy - was a significant factor in predicting seizure freedom, although
all patients had a prolonged duration of epilepsy prior to surgery. The
group who remained seizure-free had epilepsy for an average of almost
16 years prior to surgery. The group who relapsed had epilepsy for an
average of more than 20 years prior to surgery.

Study author Dr Susan
Spencer, of the Yale
University School
of Medicine, said:

"Little is known
about seizure recurrence in patients five, 10, or 20 years after surgery,
and one year isn't enough to follow up a patient who had surgery. The
number of patients who didn't relapse in this study was larger than
we thought it would be."

In an editorial published in the same issue of Neurology, Professor
Edwin Trevathan, Director of the Pediatric
Epilepsy Center at Washington University
in St. Louis, noted:

"So few patients in the
study had surgery within the first 10 years of their epilepsy that
it is not known whether early surgical therapy
increased the odds of seizure freedom.

"Surgery has
been considered as the last treatment option for patients with intractable
epilepsy, but it is clear that surgery should be considered
sooner, especially among patients who have failed to achieve seizure
freedom without side effects after treatment with a second anti-epileptic
drug."