When Drugs Fail, Surgery May Get Epilepsy Under
TUESDAY, March 6 (HealthDay News) -- Uncontrollable temporal
lobe epilepsy affected almost every major aspect of John Keener's
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
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
The study was stopped early because the researchers had
difficulty recruiting a sufficient number of patients to
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
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.
Learn more about temporal lobe epilepsy from the
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