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MONDAY, Aug. 25, 2003 (HealthDayNews) -- Surgery to remove a small part of the brain often stops or significantly reduces seizures among people with epilepsy after medications fail to do so, a new study says.
The finding appears in the Aug. 26 issue of Neurology. Researchers looked at the long-term results of surgery among 175 adults with epilepsy who were seizure-free the first year after their operation.
Scientists from the Yale University School of Medicine found the chances of remaining seizure-free were 83 percent for three years after surgery, 72 percent for five years and 56 percent for 10 years.
Of all the patients, tracked for an average of more than eight years, about 63 percent, or 110, never suffered another seizure. And among the 65 patients who did have another seizure, more than half had one or fewer per year, a promising sign, as longer periods without seizures mean less-severe relapses, the researchers say.
"We were very encouraged by these results," says study author Dr. Susan S. Spencer, a neurologist at Yale. "It
turns out that surgery has excellent results for the very long-term treatment of a group
of people who have not been able to control their seizures with medications.
"Previously we did not have documentation of the extended relief that could be expected in most patients after one-year of seizure freedom," she adds.
Only those whose seizures start in a localized area of the brain -- so-called "partial epilepsy" -- can be treated surgically. Generalized seizures are a result of abnormal neuronal activity in many parts of the brain.
About 60 percent of all people with epilepsy have partial epilepsy, and surgery could be used much more often to help those whose seizures don't respond to medications, says Dr. Edwin Trevathan, who wrote an editorial accompanying the study.
"Epilepsy surgery is definitely underutilized, and I think the reason is because people have the perception that it's quite risky and that the next new medicine is going to work," says Trevathan, director of the Pediatric Epilepsy Center at Washington University in St. Louis.
He suggests surgery should be considered sooner among those with seizures that don't respond to medications. If two drugs fail to stop seizures, Trevathan says, surgery is much more likely to stop seizures than additional medications.
Trevathan notes, however, that few people in the Yale study had surgery within the first 10 years of their epilepsy. So the research did not prove that early surgical intervention is better than delaying surgical treatment.
"But as a general rule, the longer surgery is delayed, the more years of frequent seizures suffered by patients, further impairing their quality of life and increasing the risk of seizure-associated injuries and even death," he says.
The study did establish a link between the amount of time patients had epilepsy before surgery and the likelihood of additional seizures, or relapse.
Those who remained seizure-free had epilepsy an average of 16 years before surgery, while those who relapsed had the disease an average of 20 years before surgery, the study found.
"We're trying to encourage physicians and patients alike to consider surgery as an option earlier rather than waiting 20 years before seeking an effective therapy," Trevathan says.
Just 25 years ago, many were still afraid of cardiac bypass operations, he says, predicting that surgery for epilepsy will also become more common.
Usually, the part of the brain removed in epilepsy surgery can be taken out without consequence because it is not performing any critical functions, Spencer says.
Epilepsy is a neurological disorder in which abnormal brain activity results in repeated seizures that may involve muscle spasms, loss of consciousness or changes in behavior. More than 2.3 million Americans -- and 50 million people worldwide -- have epilepsy, says the American Academy of Neurology. Epilepsy is the most common serious neurological disorder among children.
Perhaps 30 percent of Americans with epilepsy could benefit from the surgery, Spencer says, but only a fraction of them undergo it.
"Based on what we know, it's clear that there are thousands of individuals with uncontrolled epilepsy in the United States alone who have not been considered for this kind of [surgical] treatment that may permanently cure them," Spencer says.
More information
For more on surgery to treat epilepsy, visit the Epilepsy Foundation. Check with the National Institute of Neurological Disorders and Stroke for information about epilepsy and treatments.
