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Physician Resources Home arrow Medical News arrow Surgery to treat medication-resistant epilepsy
Surgery to treat medication-resistant epilepsy
Written by NetDoc.com Medical News Feed   

CHICAGO—Persons with temporal lobe epilepsy who do not respond to medication could receive a substantial gain in life expectancy and quality of life by undergoing surgery of the temporal lobe part of the brain, according to an analysis reported in the December 3 issue of JAMA.

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Despite currently available anti-epileptic drugs, 20 percent to 40 percent of all patients with epilepsy do not respond to medical management. Temporal lobe epilepsy is the most common form of epilepsy and the most likely to be medically non-responsive, and these patients are at increased risk of premature death, according to background information in the article. An alternative form of treatment is temporal lobe resection (procedure in which brain tissue in the temporal lobe is cut away). Patients becoming seizure free after anterior (toward the front) temporal lobe resection have reduced death rates relative to patients continuing to have seizures.

"Studies have reported the effectiveness of temporal lobe resection since the 1950s, yet a minority of patients are being referred to surgery and those only after an average of 20 years of illness. For adolescents and young adults, this delay may be particularly significant during a critical period in their psychosocial development," the authors write.

Hyunmi Choi, M.D., M.S., of the Columbia University Mailman School of Public Health, New York, and colleagues conducted an analysis using a simulation model to estimate the effect of anterior temporal lobe resection vs. continued medical management on life expectancy and quality-adjusted life expectancy among patients with medication-resistant temporal lobe epilepsy. The model incorporated possible surgical complications and seizure status and was populated with health-related quality-of-life data obtained directly from patients and data from the medical literature.

Model predictions of being seizure-free 5 years and 10 years after anterior temporal lobe resection were consistent with results from published studies. The researchers found that anterior temporal lobe resection would increase life expectancy by 5.0 years, with surgery preferred in 100 percent of the simulations, and that resection would increase quality-adjusted life expectancy by 7.5 quality-adjusted life-years.

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