08 February 2009

Brain Surgery for Epilepsy Extends Life Expectancy, Study Says

Dec. 2 (Bloomberg) -- A surgery to remove a paper clip-sized sliver of brain may help some epilepsy patients live as much as five years longer than those on anti-seizure drugs, according to a computer-generated analysis of patient data and studies.

The surgery can also boost quality of life, allowing patients with temporal lobe epilepsy, the most common form of the disorder, to live more years with fewer seizures, the analysis found. The report will be published in tomorrow’s Journal of the American Medical Association.

Doctors have known the surgery to be effective since the 1950s in patients whose seizures stem from the temporal lobe, the part of the brain that processes emotions. Still, many patients that might benefit don’t get the surgery because doctors overestimate the likelihood of complications, the study’s authors said. The surgery is most effective when performed early enough to prevent permanent disabilities, said neurologist Jerome Engel, the author of an accompanying editorial.

“The objective for treatment should be no seizures and no side effects, and as soon as possible,” said Engel, a professor of neurology at the University of California, Los Angeles, in a telephone interview today. He was not involved in the study. “The longer the seizures go on, the less likely patients are to be rehabilitated.”

The report was created by using quality-of-life data obtained directly from patients and published data from medical studies to create a model. The researchers ran the model 10,000 times to get their results. The model patient used in the report was 35 years old.

Signals Disrupted

Epilepsy is an illness in which signals of the brain’s nerve cells’ are disrupted, causing seizures. The condition is incurable, and the risk of seizures means some people can’t get drivers’ licenses in certain states, according to the National Institutes of Health. About 3 million Americans are affected, causing $12.5 billion in annual costs, according to the Epilepsy Foundation.

About 20 percent to 40 percent of patients aren’t helped by anti-seizure medications, according to the study. Epilepsy drugs include Johnson & Johnson’s Topamax, Abbott Laboratories’ Depakote and Novartis AG’s Tegretol.

“The rule of thumb we use is when patients fail two medications at optimal doses, doctors should consider referring patients,” for the surgery, said Hyunmi Choi, an assistant professor of neurology at the Columbia University Medical Center and the study’s lead author.

To perform the surgery, doctors first confirm that the anterior part of the temporal lobe is causing the seizures, said Choi. If that’s where the seizure begins, doctors remove 2 to 3 centimeters of tissue.

Surgical Side Effects

Side effects of the surgery, which may be performed on children and adults, include complications from anesthesia, some sensory changes, partial loss of vision or speech, or infection, according to the Epilepsy Foundation, an advocacy group.

“The likelihood of patients noticing any cognitive changes are small,” Choi said in a telephone interview today. “Because seizures arise from that part of the brain, it’s dysfunctional already.”

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