Early surgical treatment for epilepsy

Abstract

To review recent evidence that can assist clinicians facing the challenging question of when to offer brain surgery for epilepsy. The most robust recent evidence pertains to temporal lobe epilepsy. We focus on this syndrome to assess the main issues pertaining to early surgery, which include natural history and effectiveness of medication, risks associated with continued seizures, effectiveness and risks of surgery, and cognitive outcomes in relation to timing of surgery. The evidence for performing surgery earlier is persuasive but incomplete. Recent evidence indicates that intractability, and therefore consideration for surgery, does not develop at a uniform time in surgical candidates, and that late remissions with medical treatment are not rare. Factors that may suggest sustained intractability include a larger number of medications tried, longer duration of seizures, history of status epilepticus, mental retardation, and nonidiopathic epilepsy. Adequate prospective studies, however, need to address this important question systematically. The evidence regarding morbidity, quality of life, mortality, social and cognitive function suggests that earlier surgery may be beneficial, but prospective controlled studies with standardized interventions and outcomes will be required to derive firm conclusions.