Surgical Versus Medical Treatment for Epilepsy. I. Outcome Related to Survival, Seizures, and Neurologic Deficit

Abstract

We conducted a retrospective parallel longitudinal cohort study comparing surgical and medical treatment for epilepsy. The surgical group contained 201 patients treated with resective surgery for epilepsy in Norway since the first operation in 1949 until January 1988. The 185 control group patients treated medically only were closely matched for year of treatment, age at treatment, sex, seizure type, and neurologic deficit before treatment. There was no significant difference in survival between the two groups. The total monthly seizure frequency in the first and second year after operation and last year of registration (median 9 years) was significantly lower in the surgical group than in the control group (Mann-Whitney U test, two-tailed p less than 0.0001). The patterns were similar, with significant differences for subgroups with similar pretreatment status, such as seizure frequency, age, etiology and EEG-focality. Twenty-three and four-tenths percent (n = 40) of the surgically treated, and 2.9% of the controls had contracted neurologic deficits within 2 years after treatment. The difference was significant (chi square = 32.89, p less than 0.0001). Psychosis or permanent psychotic symptoms were reported in 6.7% (n = 11) of the surgically treated patients, and we suspect a higher proportion of psychotic development in the surgical group than in the control group. We conclude that surgical treatment for partial epilepsy is more successful than medical treatment in producing seizure reduction, provided the indications for operation exist. Surgical treatment produces more neurologic deficits than medical treatment (and possibly more psychiatric morbidity), and this factor must be weighed against the reduction in seizure frequency. The two treatments are equal for longterm survival.

Factors Associated with Work Outcome After Anterior Temporal Lobectomy for Intractable Epilepsy

“…One study considered students and persons in a sheltered workshop as being employed (10). Others relied on measures undefined (14,15) or subjective (11,(16)(17)(18) measures (e.g., work "ability," "capacity," "performance," or "career outcome.") Heretofore, only five studies (10,14,16,17,19) statistically analyzed their data, and only one (19) demonstrated significant improvement in unemployment rates.…”

“…Others relied on measures undefined (14,15) or subjective (11,(16)(17)(18) measures (e.g., work "ability," "capacity," "performance," or "career outcome.") Heretofore, only five studies (10,14,16,17,19) statistically analyzed their data, and only one (19) demonstrated significant improvement in unemployment rates. Some studies (14,17,19) examined a limited number of factors as predictors of work outcome, but none performed multivariable analysis to identify factors that are independently predictive.…”

Mortality in a Consecutive Cohort of 248 Adolescents and Adults Who Underwent Diagnostic Evaluation for Epilepsy Surgery

“…There have been no randomized trials of surgery for epilepsy, generally considered the "gold standard" study design for assessing this technology-intensive, invasive procedure (1). Previous reports of epilepsy surgery outcome are limited to longitudinal case series of surgical patients, without comparison with any reference group until the work of Guldvog et al (2,3). In that study, subjects were not identified prospectively, and researchers were unable to adjust for baseline differences between surgery and nonsurgery groups using statistical methods.…”

Langzeit-Outcome nach epilepsiechirurgischen Eingriffen

“…Es existieren jedoch keine ausreichenden Daten, auf deren Grundlage Langzeitauswirkungen des Absetzens einer antikonvulsiven Medikation nach epilepsiechirurgischen Eingriffen beurteilt werden könnten. Mehrere Studien belegen, dass der Anteil von Patienten ohne Medikation nach epilepsiechirurgischen Eingriffen höher ist als in Kontrollgruppen [2,4,12,16,46]. Der Anteil epilepsiechirurgisch "heilbarer" Patienten ist jedoch derzeit unklar.…”