When Drugs Fail, Surgery May Get Epilepsy Under Control

TUESDAY, March 6 (HealthDay News) — Uncontrollable temporal lobe
epilepsy affected almost every major aspect of John Keener‘s life.

Despite trying medication after medication, Keener had to give up
driving after he had a serious accident while having a seizure. Because he
couldn’t drive, he had to drop out of college. Dating seemed an
insurmountable challenge because Keener never knew when he might have a
seizure.

But in 2006 his “life completely changed” when he underwent surgery for
his epilepsy.

“Surgery made a huge difference in my life,” said Keener, of Camarillo,
Calif. Once he got his license back, he was able to start his own
business, and he and his girlfriend, Christine Smith, are celebrating
their one-year anniversary.

“Epilepsy is a serious condition and in approximately one-third of
patients it won’t be controlled by their medications,” explained Dr.
Jerome Engel Jr., director of the Seizure Disorder Center at the
University of California, Los Angeles. “The longer someone waits for
surgery when medications aren’t working, the less the chance you can help
them live a normal life. But, for people with mesial temporal lobe
epilepsy, there’s about an 80 percent chance of becoming seizure-free
after surgery.”

Engel is the lead author of a study in the March 7 issue of the
Journal of the American Medical Association that compared continued
medical treatment to surgery in people with mesial temporal lobe epilepsy
that wasn’t helped by antiepileptic medications.

Epilepsy is a disorder that causes abnormal electrical impulses in
certain areas of the brain, according to the U.S. National Institute of
Neurological Disorders and Stroke (NINDS). These abnormal electrical
impulses may trigger a convulsive seizure, also known as a grand mal
seizure. But, they can also cause other kinds of seizures, called focal
seizures or complex partial seizures, that aren’t as easy to
recognize.

For example, Keener didn’t have the convulsive type of seizures.
Instead, he said, he just kind of “vanished for a moment.” But, while he
wasn’t aware of what he was doing when he was having a seizure, he would
sometimes still be talking.

NINDS describes this type of seizure as one that alters your state of
consciousness. People may begin doing something repetitive, like walking
in a circle, or they may continue doing whatever activity they were doing,
but they won’t have a memory of it. These types of seizures last only a
few seconds. This form of epilepsy is often referred to by the area of the
brain that’s affected. In Engel’s study, people with mesial temporal lobe
epilepsy were studied.

Many people are helped by antiepileptic medications, but for some,
drugs bring no relief. The American Academy of Neurology recommends
considering surgery if two different antiepileptic medication regimens
don’t control seizures. But, in many cases, this isn’t happening, and
Engel said that the delay in surgery after medication has failed to
control seizures can lead to severely diminished quality of life,
accidents caused by seizures and even sudden unexplained death.

He said that, on average, people who are referred for surgery have had
epilepsy for 22 years. And, he noted, that’s often too long to wait.
“Early surgery is essential to avoiding consequences of epilepsy,” Engel
stressed.

In the new study, 38 people who had been diagnosed with mesial temporal
lobe epilepsy for an average of five years were randomly assigned to
receive medication or surgery. All of the study volunteers had tried at
least two brand-name antiepileptic medications that failed to control
their seizures. People treated with medications were offered the option of
surgery when the trial was completed. Keener was in the medication group
during the study period, and opted for surgery when the trial was
over.

Surgery for this type of epilepsy involves identifying the area of the
brain that is sending abnormal electrical signals and removing that small
area, according to Engel.

At the end of two years, no one in the medication group was
seizure-free, but 85 percent of those who’d undergone surgery remained
seizure-free. Those who’d had surgery also reported a better quality of
life than those in the medication group. Also over the two years, those
who could drive a car in the surgical group went from 7 percent to 80
percent.

The most significant side effect from surgery was a decline in memory.
However, according to NINDS, uncontrolled epilepsy can also cause memory
difficulties. The study authors also noted that three people in the
medication group had severe, uncontrolled seizures (status epilepticus).

The study was stopped early because the researchers had difficulty
recruiting a sufficient number of patients to participate.

Dr. Ashesh Mehta, director of epilepsy surgery at the Comprehensive
Epilepsy Care Institute in Manhasset, N.Y., said he wasn’t surprised the
researchers had difficulty getting patients to agree to take part in a
study that randomly assigns treatments. He noted that most people know
whether they want to continue with medications or have surgery, and they
might not want to take the chance of being put into a treatment group
they’re not interested in.

Mehta said he wasn’t surprised by the study findings, either.
“Correctly selected patients will generally have a much better outcome
with surgery. Seizure freedom is one of the most important things to aim
for, but there are so many people whose lives are limited by seizures. The
earlier you get surgery, the less you may have to give up,” said
Mehta.

Both Mehta and Engel suggested that people who have tried two or more
antiepileptic medications and still have seizures that interfere with
work, school or interpersonal relationships should seek treatment at an
epilepsy center.

More information

Learn more about temporal lobe epilepsy from the Epilepsy Foundation.

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