COMMENTARY

Can Epilepsy Be Cured? Long-term Outcomes After Seizure Surgery

Andrew N. Wilner, MD

Disclosures

August 01, 2014

Seizure Control in Epilepsy

Antiepileptic drugs control seizures in 60%-70% of people with epilepsy.[1] The remaining 30%-40% resort to other therapies, such as the vagus nerve stimulator (VNS); responsive neurostimulation (RNS); deep brain stimulation (DBS), which is approved in Europe but not in the United States; ketogenic and Atkins diets; alternative and complementary therapies; and epilepsy surgery. Seizure control is essential, because the potential consequences of chronic epilepsy include psychological dysfunction, social stigma, inability to drive, lower rates of employment, reduced quality of life, and physical injury, as well as increased mortality from drowning and other accidents, status epilepticus, and sudden unexpected death in epilepsy (SUDEP).

Treatment Options

Although VNS, RNS, and DBS can reduce the number and severity of seizures, they rarely stop seizures completely.[2] Diets are difficult to follow and tend to be used primarily in children with severe seizures and developmental disability. Alternative and complementary therapies lack proven safety or efficacy. The remaining option is epilepsy surgery, which has proved to be superior to medical treatment in 2 randomized trials.[3,4] Despite its effectiveness, epilepsy surgery remains underutilized.[4]

Who Should Consider Epilepsy Surgery?

Candidates for surgery must have "drug-resistant epilepsy," defined "as a failure of adequate trials of 2 (or more) tolerated, appropriately chosen, and appropriately used antiepileptic drug regimens (whether administered as monotherapies or in combination) to achieve freedom from seizures."[5] Once patients fall into this category, it is uncommon for them to become seizure-free with continued medical management. For example, in a randomized trial of patients who were surgical candidates, 58% became seizure-free after temporal lobe surgery compared with only 8% who received continued medical therapy.[3]

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