Brainsurgery
Wednesday, March 4, 2015

In the January 20, 2015 issue of the journal JAMA, Doctors Jobst and Cascino from Dartmouth and Mayo Clinic present a review of epilepsy surgery used for focal epilepsy. With a MEDLINE and Cochrane database search, 55 articles were included in this systematic review.

  • They found two randomized clinical trials enrolling 118 people with temporal lobe epilepsy. People in those trials found greater freedom from seizures with surgery when compared with continued medical treatment, 58% vs. 8% and 73% vs. 0% for each respective trial. 
  • Nine systematic reviews and two large case series of people with medically refractory seizures treated with surgery reported seizure free outcomes in 34 to 74% of the cases. 
  • Epilepsy surgery was less effective for extratemporal lesions when the seizures were not associated with a structural lesion or both. 
  • Seizure free outcomes were similar between children and adults.
  • Hippocampal sclerosis and benign tumors were associated with better outcomes relative to other pathologies.
  • Similar procedures, such as selective amygdalohippocampectomy and temporal lobectomy for temporal lobe epilepsy, were associated with subtle differences in seizure and neuropsychological outcome. 
  • There was low perioperative mortality from epilepsy surgery. 
  • The most frequent complication is visual field defect occurring from temporal lobe resection.
  • Quality of life improved after surgery but improved the most in people who were seizure free after surgery. 

The authors concluded that epilepsy surgery reduced seizure activity in randomized clinical trials when compared with continued medical therapy. Despite good outcomes from high quality clinical trials, referrals of patients with seizures refractory to medical treatment remain infrequent.

Authored by: Joseph I. Sirven MD on 3/2015