Neurology Medical News about refractory epilepsy, anterior temporal lobectomy

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Refractory seizures: Try additional antiepileptic drugs (after two have failed) or go directly to early surgery evaluation?
Epilepsia, 08/24/09

Kwan P et al. – A review of antiepileptic drugs failure vs surgery in refractory seizures recommends that pts be promptly referred for a comprehensive review of diagnosis and management, including surgery evaluation. The decision to offer surgical treatment requires individual risk–benefit analysis with assessment of possible success with additional trials of medication.

Methods

Review of antiepileptic drugs failure vs surgery in refractory seizures

Results

Goal of antiepileptic therapy: long-term seizure freedom with minimal or no adverse effects
Pts with 2 antiepileptic drugs (AEDs) failed due to lack of efficacy may have a low chance of subsequent seizure freedom with further AEDs (up to ~25% of pts)
Surgery: seizure-free success for up to 70% of pts with temporal resection vs 25% of pts with frontal resection
Both approaches (AED/surgery) are associated with potential adverse outcomes

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