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Am Fam Physician. 2002;65(4):708

Epilepsy affects five to 10 persons per 1,000 population in North America and is the second most common cause of mental health disability, especially among young adults. Most epilepsy cases are caused by temporal lobe lesions, which can have subtle behavior and sensory presentations. Surgical treatment of temporal lobe epilepsy (TLE) has the potential not only to control seizures, but to prevent untimely death. However, surgery seems to be grossly underused because many physicians are unsure about the safety and efficacy of surgical procedures. Wiebe and associates conducted a randomized, controlled trial comparing surgical treatment of TLE with standard medical therapy.

Study candidates had consistently poor control while taking seizure medications. They also had electroencephalographic evidence of a unilateral temporal lobe focus and no signs of extratemporal disease on magnetic resonance imaging of the brain. Patients randomized to surgery underwent resection of the anterior temporal lobe on the abnormal side and continued taking seizure medications postoperatively.

Researchers randomized 40 patients to each treatment arm, but for various reasons four patients in the surgical group ultimately did not undergo surgery. Adverse effects related to surgery occurred in four of 36 patients, including a wound infection, a small thalamic infarct, and memory problems that were substantial enough to interfere with the occupational performance of two patients.

During a one-year follow-up period, changes in anticonvulsant medications were necessary in 100 percent of patients in the medical therapy group compared with 22 percent of those treated surgically. Seizure-free status after one year occurred in 38 percent of surgical patients and 3 percent of medical therapy patients. Quality-of-life scores were higher among those treated surgically, although the number of patients who were able to remain employed or in school did not increase significantly.

The authors conclude that resection of the temporal lobe in patients with appropriate brain lesions and a history of poor epileptic control while taking medications is associated with better control of seizures, less need for medication adjustments, and increased quality of life.

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Copyright © 2002 by the American Academy of Family Physicians.

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