Brain Surgery an Alternative When Seizure Drugs Fail
Aug. 1, 2001 -- Brain surgery for seizures sounds pretty drastic, but a report in this week's New England Journal of Medicine recommends it when drugs fail to help people with temporal lobe epilepsy. This condition affects tens of thousands of people in the U.S., and symptoms may involve losing touch with reality, hallucinations, or automatic movements like lip-smacking or picking at clothing.
"There should be no doubt now that surgical treatment works, at least for appropriately selected patients," Jerome Engel Jr., MD, PhD, tells WebMD.
Whether surgery is the best approach and, if so, when it should be performed are questions that need to be considered before deciding, says Engel, a professor of neurology at UCLA who wrote an editorial that accompanies the NEJM paper.
Although they studied only adults, researchers Samuel Wiebe, MD, and Warren T. Blume, MD, from the University of Western Ontario in London, Canada, feel that surgery may also help children.
The earlier the surgery is done, the less likely seizures are to affect children socially and psychologically in those important early years, Wiebe tells WebMD. "It's futile to continue trying many different drugs for many years."
"Uncontrolled epilepsy poses a risk for death, injury, and impaired quality of life and can eventually cause brain damage," Kimford J. Meador, MD, professor of neurology at the Medical College of Georgia, in Augusta, tells WebMD after reviewing the study.
Because of unfounded fears of surgery, most patients with uncontrolled seizures wait up to 20 years to have it done. "Hopefully, these findings will encourage consideration of this treatment earlier," Meador says.
Of 80 patients with temporal lobe epilepsy, half were assigned to receive surgery, while the others received drugs. One year later, 58% of those who had surgery were free of seizures, compared with 8% of those who did not.
One patient who did not have surgery died. Quality of life was better in those who had surgery, although four patients had side effects, including two who experienced memory loss severe enough to interfere with their work.
"The surgery is not to be taken lightly," Blume says. "The brain is so complex that you need to have it done by a neurosurgeon who appreciates that complexity, in a center with extensive experience and expertise."
Thanks to remarkable advances in diagnosis and treatment at academic centers -- including sophisticated techniques to view brain structure and function -- surgical results are much better in selected patients, Stephan Eisenschenk, MD, assistant professor of neurology at the University of Florida in Gainesville, tells WebMD when asked for independent comment.
These experts recommend that patients who continue to have seizures while on antiseizure drugs see a neurologist first, with a referral for the surgery to an experienced center if appropriate.