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Surgery "preferable to medication" in temporal lobe epilepsy

4 March, 2003

Researchers have called on doctors to consider surgery as more preferable treatment than medication for people with temporal lobe epilepsy.

The study, published in the journal Neurology, showed that surgery left 64 per cent of patients free of seizures at the end of one year and 10 per cent to 15 per cent unimproved, while medication left just 8 per cent free of seizures.

Dr Jerome Engel, professor of neurology and neurobiology at the David Geffen School of Medicine at UCLA, said:

"Our comprehensive review of a decade’s worth of research findings shows that surgery as a treatment for disabling seizures caused by this form of epilepsy is clearly superior to medication, and the risks are at least comparable. Patients with TLE (temporal lobe epilepsy) who haven’t responded to medication should seriously consider surgery as their treatment of choice."

The risks from surgery were quantified as small. No surgery-related deaths were reported, but one patient treated medically died. Surgical complications were reported in 11 per cent of 556 patients from seven centres reporting in the study; 3 per cent suffered permanent neurological deficits. Post-operative cognitive and behavioural difficulties were described in only three papers, where they occurred in 6 per cent of patients. Half of these were permanent.

The researchers conclude:

"The potential for achieving freedom from seizures offered by surgical treatment, as opposed to continuing medication therapy, may reduce the risks of long-term morbidity. In addition, successful surgical intervention appears to reduce the risk of mortality from continuing epileptic seizures substantially. This reduction in death rate offsets the irreversible surgical complication rate."