Brain Surgery For Seizures Ten Years On

Long term outcomes for resective surgery to reduce and eliminate seizures are positive

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) For the 30 percent of epilepsy patients that have difficulty controlling their condition with prescription drugs, surgery is often the recommended option. Studies have shown good results two to five years after the surgery, but what can be expected even further down the line?

A recent study looked at the long term effects of brain surgery as a means to control epilepsy. Seventy-three percent of patients had a good outcome after resective surgery, the procedure in which the portion of the brain responsible for the seizures is removed.

In addition, 28 percent of study participants were seizure-free after receiving the brain surgery.

"Discuss the pros and cons of surgery with your neurologist."

Vibhangini S. Wasade, MD, of the Henry Ford Hospital and colleagues followed 202 patients who received resective surgery. The patients were reduced from 470 total surgeries in the Henry Ford Health System corporate Data Store between 1993 and 2011.

The researchers examined the study participants' electronic medical records and followed up with them via phone surveys. The phone surveys were made in May of 2012 to determine how frequently each patient had seizures.

The mean age of the study participants was 46.6 years. The time between epilepsy onset and surgery was an average of 20.8 years.

Most patients stay on anti-epileptic drugs after resective surgery for at least several years. In this study, the average number of drugs taken for epilepsy before and after surgery was 2.1.

The follow-up occurred at an average of 10 years after the surgery with 24 percent of patients having a follow-up period of 15 years or longer.

A positive outcome was defined by class I and class II of Engel’s classification, the most commonly used seizure outcome scale. Class I is anyone free of disabling seizures and Class II includes those who are almost seizure-free.

Forty-seven percent of study participants received resection surgery after scalp electroencephalography (sEEG) monitoring and the remaining 53 percent received the surgery after extra-operative electrocorticography (eECoG).

sEEG is the recording of electrical activity along the scalp. eECoG uses electrodes placed directly on the brain to record the cerebral cortex’s electrical activity.

eECoG is considered to be superior to sEEG because it is more precise. eECoG is widely used for pre-surgery planning to determine the area of the brain to be resected.

Most outcomes remained positive throughout the follow-up period. The least number of those with a favorable outcome was 63 percent and occurred in the group which was 5-10 years post-surgery.

Seventy-six percent of those who were less than five years post-surgery had a positive result. Seventy-eight percent of those more than ten years post-surgery had a positive result.

The best results in this study occurred in patients who received resective surgery after sEEG and who received the resection in the temporal region of the brain.

These results were independent of any individual diagnosis.

The study did not assess any psychosocial outcomes of the surgery like memory loss, language difficulties or psychiatric disorders including anxiety and depression.

The study was presented at the American Epilepsy Society Annual Meeting in San Diego. All research presented at academic meetings should be considered preliminary until published in a peer-reviewed journal.

No conflicts of interest were reported.

Reviewed by: 
Review Date: 
January 3, 2013
Last Updated:
January 4, 2013