Surgery a Successful Treatment Option for Certain Epilepsy Seizures Help
for Epilepsy
www.mayoclinic.org / www.mayoclinic.com


ROCHESTER, Minn. -- A study of ten years of patient outcomes shows that
surgery is not only effective, but the preferred treatment for select
epilepsy patients. In the most comprehensive study of long-term surgery
success rates, Mayo Clinic physicians report that 73 percent of 491 Mayo
Clinic patients were either seizure-free or experienced seizures only
when medication was discontinued.

The study included epilepsy surgical outcomes between 1988 and 1998.
Patient follow-up reports ranged from one to 14 years, with an average
length of six years. Results will be presented April 27 at the American
Academy of Neurology annual meeting in San Francisco by Gregory Cascino,
M.D., chair of the Mayo Clinic Division of Epilepsy, Department of
Neurology. The study further shows that if seizures occurred following
epilepsy surgery, they usually did so in the first year -- and that this
first-year recurrence is a reliable indicator of the procedure's
long-term success. The surgery involves removing the epileptic brain
tissue, a procedure called a focal cortical resection.

These findings are welcome news for patients with "intractable partial
epilepsy." Thirty to 40 percent of partial epilepsy patients do not
respond to medication, and are therefore diagnosed as suffering from
intractable epilepsy. "Partial epilepsy" refers to seizures that
originate from a specific region of the brain, rather than from both
cerebral hemispheres. Partial epilepsy is the most common seizure
disorder, affecting over one million patients in the United States and
comprising 90 percent of adult epilepsy cases.

"These data strengthen what we've long suspected, that is, that
individuals with intractable partial epilepsy should be referred as
early as possible in the course of treatment to comprehensive epilepsy
centers for consideration of surgery," says Dr. Cascino.

Significance of the Mayo Clinic Findings

Intractable partial epilepsy has long been regarded as especially
disabling. By some estimates, intractable partial epilepsy costs
individuals and society $12 billion annually for medical treatment, lost
wages, psychosocial disturbances and related medical conditions.

"Most patients with intractable partial seizures that originate in the
temporal lobe experience two to four seizures a month," explains Dr.
Cascino. "However, even one seizure per month may radically and
negatively affect a person's quality of life - so any new relief we can
offer patients is a real gain. Our data suggest that surgical
treatments, in some cases, are more effective in reducing seizure
activity than other forms of therapy, and that's really great news."
About Partial Epilepsy

Partial epilepsy is characterized by recurrent seizures produced by
abnormal excitability and excessive energy discharge of neurons in the
brain. These disturbances may be biochemical, and/or consist of
structural abnormalities, injuries or growths on the brain. The cause of
partial epilepsy is not known.

A patient's early response to anti-epileptic drug medication is highly
predictive of its ultimate success as a treatment. Studies show that if
a patient's seizures are not controlled by drugs within five years of
diagnosis, medication likely will not prove successful. About the Mayo
Clinic Study

The Mayo Clinic researchers reviewed long-term outcomes of epilepsy
surgery in a large group (491 patients) diagnosed with intractable
partial epilepsy and treated at Mayo Clinic Rochester. Previous studies
by others have followed small groups of patients for one to two years.

The researchers' objectives were to identify and evaluate preoperative
factors that may play a role in producing the best surgical outcomes.
This information will help choose candidates best suited for epilepsy
surgery. Statistically, positive surgical outcomes are more likely among
women, rather than men, and among patients who've not had prior
surgeries. The procedure is more successful if thepatient has seizures
that originate in the temporal lobe of the brain. ###