A new multi-center study led by UCLA researchers has found that surgical treatment for patients suffering from one type of epilepsy can profoundly improve their life; however, most avoid undergoing the operation. They published their findings in the March 7 edition of the Journal of the American Medical Association (JAMA). Individuals who suffer from a form of epilepsy known as medically intractable epilepsy continually experience seizures because they are resistant to drug treatment. These people cannot drive and cannot work; furthermore, they seizures result in a cumulative loss of cognitive function. Premature death is not uncommon.
The study found that for individuals suffering from intractable temporal lobe epilepsy, the most common form of intractable epilepsy, early surgical intervention followed by antiepileptic drugs stopped their seizures, improved their quality of life, and helped them avoid decades of disability. “In short, they got their lives back,” noted Dr. Jerome Engel, the study’s principal investigator and director of the UCLA Seizure Disorder Center.
Dr. Engel and his colleagues note that they are frustrated by the fact that only a few patients with medically intractable epilepsy are referred to them for surgical evaluation; furthermore, those that are referred have suffered from the condition for an average of 22 years. “By then, it’s often too late,” he said. “These people will likely remain disabled for life.”
A total of 16 epilepsy centers in the U.S. participated in the study; 38 individuals suffering from mesial temporal lobe epilepsy that was determined to be intractable were recruited. These patients continued to have seizures after trying two different anti-epileptic drugs (the international definition of medical intractability). To be included in the study, the participants had to be within two years of having their disease declared intractable. Of the 38 patients, 15 underwent surgery and 23 were assigned to a program of best medical care.
The investigators reported that after two years, 85% of the participants who underwent surgery were seizure-free in the second year after the procedure; in comparison, none in the medical care group were seizure-free. Furthermore, the surgical group also reported a significantly higher quality of life, a significant increase in independence, and an improved willingness and ability to socialize with friends and family. Two years after the surgery, the number of individuals who reported being able to drive a car rose from 7% to 80% in the surgical group. Cognitive problems such as memory loss were similar between both groups.
“The results of this study are very encouraging,” noted Dr. Engel, who holds the Jonathan Sinay Chair in Epilepsy at UCLA. He added, “Surgical treatment for temporal lobe epilepsy soon after the failure of two trials of anti-epileptic drugs stops seizures and improves quality of life. Continuing anti-epileptic drug treatment alone does not. So the message is clear: Early surgery, before the adverse social and psychological consequences of seizures become irreversible, offers the best opportunity to avoid a lifetime of disability.”
“This study shows that early surgical intervention works, it stops seizures and it improves quality of life,” noted Dr. Karl Kieburtz, director of the Center for Human Experimental Therapeutics at the University of Rochester Medical Center, which served as the coordinating center for the study. “Individuals with epilepsy that is not controlled with medicine should be evaluated for surgical intervention at a comprehensive epilepsy center — not after decades of poor response to medicine but within two years. And if they are a surgical candidate, they should give strong consideration to that approach.”
Dr. Engel noted that the results were statistically significant, even though the study was terminated early due to slow enrollment. The study originally was intended to follow 200 patients; however, only 38 were ultimately recruited. Some patients who were referred did not meet the study’s criteria; however, the major problem was a lack of referrals. Dr. Engel is not sure why; however, he said, “Partly, it has to do with the larger number of available anti-epileptic drugs, so neurologists in the community will try more combinations of medications. Also, there are many misconceptions about surgical criteria that prevent the referral of good candidates. If patients have intractable seizures, they should be given the opportunity to be evaluated at an epilepsy center. But the biggest reason is fear — that’s often cited by patients and their physicians as a reason for continuing drug therapy. They see surgery as a last resort. And this study shows that that’s just wrong.”
The authors note that epilepsy is a brain disorder that produces sudden and repeated seizures that last from a few seconds to several minutes. Seizures are brief attacks of altered consciousness, muscle control, or sensory perception. During a seizure, some brain cells behave abnormally, firing repeatedly. This usually begins with a small group of cells and spreads to involve a larger area of the brain. Epilepsy affects nearly 3 million Americans and 50 million people worldwide; the health burden caused by the disease is equivalent to that of lung cancer in men and breast cancer in women. In the United States, 30–40% of epilepsy patients who suffer from medically intractable epilepsy account for 80% of healthcare costs for the disorder.