Epilepsy Sparks

Surgery or Medical Treatment in Drug-Resistant Epilepsy in Children


Surgery or Medical Treatment in Drug-Resistant Epilepsy in Children

I'm Marcin Kopka MDa Neurologist at the Military Institute of Aviation Medicine1 (Warsaw, Poland).

I’m particularly interested in the treatment of people with both epilepsy and migraines.

 

Favourite bands: Depeche Mode2ABBA3

Favourite sports: Swimming & snooker

Favourite film:     12 Angry Men4


Epilepsy is one of the most common neurological diseases in the world. It affects about 70 million people worldwide.5 Despite the availability of over 25 medications to treat epilepsy; current data suggests that up to 80% of patients could be seizure free with the correct Anti-Epileptic Drug(s).6

 


The aim of the study published in the New England Journal of Medicine was to compare epilepsy surgery with continued medical therapy alone; in pediatric patients on a waiting list for surgery.7 In this single-center trial: 116 patients with drug-resistant epilepsy were randomized into two groups where they either: 


      ·    Underwent brain surgery targeting the underlying cause of their epilepsy along with appropriate medical therapy (described in the study as “surgery group”; 57 patients), or;

      ·    Received medical therapy alone (described in the study as the “medical-therapy group”; 59 patients).



After 12 months, seizure freedom occurred in 44 patients (77%) of whom were in the surgery group and 4 patients (7%) of whom were in the medical-therapy group (P<0.001) 7. In this trial, patients having epilepsy surgery had a significantly higher rate of freedom from seizures than did those who continued medical therapy alone.7



 

In the group of surgical candidates the proportion of individuals that are seizure free after surgery ranged from 5080%.8 Surgery seems cost-effective and better than the best medical treatment in terms of seizure control and quality of life 9-10.


Marcin Kopka MD.

Neurologist, Military Institute of Aviation Medicine

References

1.Military Institute of Aviation Medicine: http://www.wiml.waw.pl/?q=en

2. Depeche Mode: http://www.depechemode.com/

3. ABBA: https://abbasite.com/

4. IMDb: https://www.imdb.com/title/tt0050083/ 

5. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014; 55: 475–482. https://onlinelibrary.wiley.com/doi/full/10.1111/epi.12550

6. Neligan A, Hauser WA, Sander JW. The epidemiology of the epilepsies. Handb Clin Neurol 2012;107:113-133 https://www.sciencedirect.com/science/article/pii/B9780444528988000069?via%3Dihub

7. Dwivedi R, Ramanujam B, Chandra PS, et al. Surgery for drug-resistant epilepsy in children. N Engl J Med 2017; 377: 1639-1647. htthttps://www.nejm.org/doi/pdf/10.1056/NEJMoa1615335

8. Ryvlin P, Cross JH, Rheims S. Epilepsy surgery in children and adults. Lancet Neurol 2014; 13: 1114-1126. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70156-5/fulltext

9. Picot MC, Jaussent A, Neveu D, et al. Cost-effectiveness analysis of epilepsy surgery in a controlled cohort of adult patients with intractable partial epilepsy: a 5-year follow-up study. Epilepsia 2016; 57:1669-1679 https://onlinelibrary.wiley.com/doi/full/10.1111/epi.13492

10. Dwivedi R, Ramanujam B, Chandra PS, et al. Surgery for drug-resistant epilepsy in children. N Engl J Med 2017; 377:1639–1647. https://www.nejm.org/doi/full/10.1056/NEJMoa1615335

Comment



I was on anticonvulsants from the age of 7 with NO reduction of the seizures. Had the surgery in February 1991 and was gradually reduced off of all the medication [over 6,000mg of a concoction of many drugs per day]. Have been seizure free since the surgery and drug free since 1996. I would FULLY recommend the surgery PROVIDING the neurologist and the surgical team were in agreement that it could work. Best to try than to live with the "WHAT IF" scenario for the rest of your life.