Brain surgery for epilepsy underutilized
Also, many people with epilepsy are not getting the specialty care needed to properly identify the source of the seizures. The study found a significant trend that patients are being evaluated less at epilepsy centers and more at community hospitals often without dedicated epilepsy expertise. The result is that some patients may not receive an adequate workup, and in many cases, the source of the seizures can be very difficult to find without special expertise. “The success of epilepsy surgery totally depends upon the accurate localization of seizure onset region,” Chang said.
The decade-old Canadian study showed that more than nearly two-thirds of all people who underwent surgery as part of the study in the 1990s were seizure-free. Fewer than 10 percent of patients in the study who relied on drugs alone achieved the same degree of freedom from seizures.
Epilepsy Study Shows Memory Loss After Brain Surgery
Epilepsia, the official publication of the International League Against Epilepsy, recently published a one-year follow-up study that finds some post-surgical epilepsy patients have a significant decline in verbal memory. This type of memory loss is associated with learning, recall and recognition.
Three months after surgery, patients with surgery performed on either the left or right brain tissue showed signs of verbal memory loss. Initially, the resulting loss of memory was thought to be a possible effect of the trauma of surgery. However, 12 months later 30% -50% of those patients who experienced surgery to the left temporal lobe showed no recovery of verbal memory, while patients who had surgery on the right side of their brain regained their memory. The results indicate that the decline observed in a small portion of patients who had surgery on the right side of their brains was temporary and most likely the effects of complications in surgery. Verbal memory loss mainly affects those patients whose surgery was performed on the left side of the brain.
Selective Amygdalohippocampectomy (SAH), or mesial temporal lobectomy, was the type of surgery performed on the 115 patients studied. “It was not clear from existing studies to what extent an SAH can lead to significant declines in memory functions, which memory functions are at risk of becoming impaired, and which determinants of outcome can be discerned,” observed author Ulrike Gleissner, PhD.
As a type of epilepsy surgery, SAH was originally developed to spare unaffected brain tissue from resection and thus to minimize the negative consequences of anterior temporal lobectomy, a more conventional surgical technique. Most often SAH is sufficient to eliminate recurrent seizures in patients.
“Even though this important evidence was published 10 years ago now, we have not seen increases in the number of patients,” Chang said. “We need to do better.”
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Jason Socrates Bardi
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University of California - San Francisco