Surgery for temporal lobe epilepsy

Highly effective but remains underused

In a worldwide review of epilepsy surgery carried out in 1985, 53 centres were found that had undertaken about 3500 operations for intractable epilepsy. Five years later this had increased to over 8000 operations done in 118 centres.1 In both surveys most patients underwent resections for temporal lobe epilepsy. Specialist services for epilepsy and intensive electroencephalography monitoring are now more widely available and presurgical evaluation has become easier due to advances in neuroimaging.

Any doubts that surgery is not effective have been dispelled by a recent randomised study.2 Patients were assigned to surgery or a one year waiting list control group where they received optimum medical treatment. This study design avoided any ethical objections to delaying surgery. Fortunately, only 10% of the patients were excluded after investigation so an appropriate intention to treat analysis could be undertaken. With medical treatment only 5% remitted, while after surgery 65% were completely seizure free. The study design did however restrict comparative outcomes to one year of follow up, …