Surgery Reduces Seizures in Treatment-Refractory Epilepsy

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The researchers found that 71.9% of operations involved the temporal lobe.
The researchers found that 71.9% of operations involved the temporal lobe.

HealthDay News — For pediatric patients with drug-resistant epilepsy, surgery can improve freedom from seizures, and among adults with drug-resistant focal epilepsy undergoing surgery, hippocampal sclerosis is the most common histopathological diagnosis, according to two studies published in the New England Journal of Medicine.

Rekha Dwivedi, PhD, from the All India Institute of Medical Sciences, and colleagues randomized 116 patients aged 18 years or younger with drug-resistant epilepsy to undergo brain surgery appropriate to the underlying cause of epilepsy plus medical therapy (57 patients) or to medical therapy alone (59 patients). The researchers found that freedom from seizures occurred in 77% and 7% of patients in the surgery and medical-therapy groups, respectively, at 12 months (P <.001).

Ingmar Blumcke, MD, from University Hospital Erlangen in Germany, and colleagues reported diagnoses based on resected brain specimens from 9523 patients who underwent epilepsy surgery for drug-resistant seizures. Overall, 75.9% of patients had onset of seizure before 18 years of age, and 75.2% of patients underwent surgery as adults. The researchers found that 71.9% of operations involved the temporal lobe. Thirty-six histopathological diagnoses in 7 major disease categories were identified; the most common categories were hippocampal sclerosis (in 36.4% of patients [88.7% of cases were in adults]), tumors (in 23.6%), and malformations of cortical development (in 19.8% [52.7% of cases were in children]).

"The data from this large series add to the information on microscopically defined pathologic conditions in specimens obtained from surgical resection in patients with drug-resistant focal epilepsy," Dr Blumcke and colleagues wrote.

Disclosures: Several authors from the Blumcke study disclosed ties to the biopharmaceutical industry, and one holds patents.

Reference

  1. Dwivedi R, Ramanujam B, Chandra S, et al. Surgery for drug-resistant epilepsy in children. N Engl J Med. 2017;377:1639-1647
  2. Blumcke I, Spreafico R, Haaker G, et al. Histopathological findings in brain tissue obtained during epilepsy surgery. N Engl J Med. 2017;377(17):1648-1656.
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