Product information and disease description Place of product in therapy Approaches to treatment Current treatment options and standard of care

Epilepsy surgery

7 evidence topics · 6 sources

Referral for resective epilepsy surgery

“Refer people with drug-resistant epilepsy, including those without identified MRI abnormalities, for consideration of assessment for resective epilepsy surgery:” (opens the source at this quote in a new tab)
“For adults, this should be to a tertiary epilepsy service.” (opens the source at this quote in a new tab)

Role and outcomes of resective surgery

“Epilepsy surgery is the treatment of choice for patients with drug-resistant seizures.” (opens the source at this quote in a new tab)
“Resective surgery can improve quality-of-life and cognitive outcomes and is the only treatment demonstrated to improve survival and reverse excess mortality attributed to drug-resistant epilepsy (DRE)” (opens the source at this quote in a new tab)
“Yet, referral for surgical evaluations is often delayed while palliative options are pursued, with significant adverse consequences due to increased morbidity and mortality associated with intractable epilepsy.” (opens the source at this quote in a new tab)

Timing of referral for surgical evaluation

“Referral for a surgical evaluation should be offered to every patient with drug-resistant epilepsy (up to 70 years of age), as soon as drug-resistance is ascertained, regardless of epilepsy duration, sex, socioeconomic status, seizure type, epilepsy type (including epileptic encephalopathies), localization, and comorbidities” (opens the source at this quote in a new tab)
“A surgical referral should be considered for older patients with drug-resistant epilepsy who have no surgical contraindication, and for patients (adults and children) who are seizure-free on 1–2 anti-seizure medications (ASM)s but have a brain lesion in non-eloquent cortex” (opens the source at this quote in a new tab)

Randomized trial of surgery for temporal lobe epilepsy

“At one year, the cumulative proportion of patients who were free of seizures impairing awareness was 58 percent in the surgical group and 8 percent in the medical group (P<0.001).” (opens the source at this quote in a new tab)
“In temporal-lobe epilepsy, surgery is superior to prolonged medical therapy.” (opens the source at this quote in a new tab)
“Four patients (10 percent) had adverse effects of surgery. One patient in the medical group died.” (opens the source at this quote in a new tab)

Randomized trial of early surgery in newly intractable temporal lobe epilepsy

“Zero of 23 participants in the medical group and 11 of 15 in the surgical group were seizure free during year 2 of follow-up” (opens the source at this quote in a new tab)
“Among patients with newly intractable disabling MTLE, resective surgery plus AED treatment resulted in a lower probability of seizures during year 2 of follow-up than continued AED treatment alone.” (opens the source at this quote in a new tab)
“Patients are typically referred for surgery after 20 years of seizures, often too late to avoid significant disability and premature death.” (opens the source at this quote in a new tab)

Practice parameter on temporal lobe resection

“A single Class I study and 24 Class IV studies indicate that the benefits of anteromesial temporal lobe resection for disabling complex partial seizures is greater than continued treatment with antiepileptic drugs, and the risks are at least comparable.” (opens the source at this quote in a new tab)
“For patients who are compromised by such seizures, referral to an epilepsy surgery center should be strongly considered.” (opens the source at this quote in a new tab)

Laser interstitial thermal therapy for mesial temporal lobe epilepsy

“At both 1- and 2-years after LITT, 58.0% achieved Engel I outcomes.” (opens the source at this quote in a new tab)
“LITT is a viable treatment for mTLE in patients who have been properly evaluated at a comprehensive epilepsy center.” (opens the source at this quote in a new tab)