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In epilepsy patients, once a few antiepileptic medications have been tried unsuccessfully, the chance of lasting seizure freedom with additional medical therapy is less than five percent. By contrast, with surgery for many times of epilepsy well over 70 percent of patients who failed medication can realize complete seizure freedom, and even more will be either seizure-free or significantly improved.
Yet surgery is under-utilized.
At West Virginia University’s Epilepsy Center, the average duration patients have experienced medically intractable seizures before surgery is 24 years. And that is typical of national figures. Yet for most patients a determination that their epilepsy may be intractable can be made within just a few years of seizure onset and trials of two or three standard anticonvulsants.
Patients with persisting and disabling seizures have morbidity and mortality rates several times greater than the general population. But patients who become seizure free as a result of surgery reduce their risk of death and injury to that of the general population, according to one large study. (Sperling et al. JAMA. 1996) Timely surgical intervention for intractable epilepsy can save lives as well as improve the quality of life.
Who is a Candidate for Surgery?
Based on the evidence that selected individuals can benefit from surgery for epilepsy, the American Academy of Neurology, American Epilepsy Society, and American Association of Neurological Surgeons recommend that all patients with epilepsy who have tried and failed the standard first-line anticonvulsant medications should be evaluated within a comprehensive epilepsy program.
Among American who develop epilepsy, up to 70 percent will have their seizures adequately controlled by medication. At least 30 percent may continue to have seizures that are intractable to medication. Of these patients, about one in three will meet the criteria for surgical intervention.
The appropriateness of surgery for any given patient can only be determined by a rigorous process of evaluation such as that available at a comprehensive epilepsy center.
The earlier in life seizures can be controlled, the more likely an individual will develop normal interpersonal skills and integrate successfully into society. Surgery for epilepsy is an important treatment option in children who have failed medical therapy. In older patients, surgery is well-tolerated by those in moderately good health. There is essentially no risk of mortality in any age group from modern epilepsy surgery, morbidity risks are very low, and the age of the patient does not impact the opportunity for good results from surgery. (Bowling, J Neurosurg 2001)
On average, over 52 surgical procedures for epilepsy are performed per year. Average breakdown:
