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Surgery for Temporal-Lobe Epilepsy

Surgery for temporal-lobe epilepsy is not performed commonly, possibly because there have been no randomized controlled trials of this approach. Canadian researchers therefore undertook this study, which included 80 patients (mean age, 35) with poorly controlled temporal-lobe epilepsy despite the use of 2 or more anticonvulsant drugs for at least 1 year.

Patients were randomized to undergo surgery (i.e., resection of part of a temporal lobe) or to receive continued medical therapy; patients in the surgery group continued their medications for at least 9 months postoperatively. At 1 year, the proportion of patients who were free of seizures that impaired awareness was significantly greater in the surgical group than in the medical group (58% vs. 8%). Improvement in quality of life also was significantly greater in the surgical group. Surgical complications occurred in 4 patients: 1 experienced a small thalamic infarct, 1 suffered a wound infection, and 2 had declines in verbal memory that interfered with their occupations.

Comment: On the basis of this trial, the authors and an editorialist enthusiastically endorse surgery for epilepsy; however, the procedure is not without potential complications. One limitation of this study is the relatively short 1-year follow-up; in addition, the optimal timing of surgery remains unclear.

— AS Brett

Published in Journal Watch General Medicine August 7, 2001

Citation(s):

Wiebe S et al. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001 Aug 2 345 311-318.

• Original article (Subscription may be required)
• Medline abstract (Free)

Engel J Jr. Finally, a randomized, controlled trial of epilepsy surgery. N Engl J Med 2001 Aug 2 345 365-367.

• Original article (Subscription may be required)
• Medline abstract (Free)