New data further supports the rationale that epilepsy surgery be considered early on for patients with treatment-resistant epilepsy. The study, which explored mortality rate after epilepsy surgery, was published in Neurology.
Michael R. Sperling, MD, of the Jefferson Comprehensive Epilepsy Center at Thomas Jefferson University in Philadelphia, and colleagues evaluated a total of 1110 patients from 1986 to 2013 who were treated both with (n=1006) and without (n=104) surgery. Patients were grouped based on surgery type and seizure status, and patient deaths were tracked through database and Social Security Death Index query.
Overall, 89 deaths were observed over the follow-up period. Patients who underwent surgery had a lower mortality rate (8.6 per 1,000 person-years [95% confidence interval (CI) 6.58–11.15]) than those who did not (25.3 per 1,000 person-years [14.50–41.17]; P < 0.001). A similar trend was seen in patients who were seizure free (5.2 per 1,000 person-years [95% CI 2.67–9.02]) compared to those who continued to have seizures (10.4 per 1,000 person-years [95% CI 7.67–13.89] P = 0.03). A greater frequency of postoperative tonic-clonic seizures (>2 per year) was associated with an increased mortality rate. Notably, frequency of complex partial seizures was not linked to mortality rate, and a similar mortality rate was observed in both temporal and extratemporal epilepsy patients (P=.7)
The results indicate that epilepsy surgery is beneficial in terms of mortality rate in patients with refractory epilepsy, regardless of whether seizures are eliminated or significantly reduced. This evidence supports the notion that these patients be considered for epilepsy surgery early on in treatment.