BRECKENRIDGE, COLO. — Recent research findings enable physicians to counsel patients with drug-refractory temporal lobe epilepsy much more effectively about the risks and benefits of resective surgery, Lauren C. Frey, M.D., said at a conference on epilepsy syndromes sponsored by the University of Texas at San Antonio.
“Chronic seizures carry their own risks. If you ignore that, you're really missing the boat in trying to decide whether or not to offer someone epilepsy surgery,” said Dr. Frey, a neurologist at the University of Colorado, Denver.
Investigators at the University of Göteborg (Sweden) performed formal neuropsychologic testing in 36 adults with a mean age in their early 30s who had long-time, drug-resistant partial epilepsy and in a healthy control group matched for age, gender, and education level, said Dr. Frey. Cognition at baseline was worse in patients with intractable epilepsy than controls. At follow-up testing 5 years later, patients showed further significant declines in general cognition and verbal memory (Epilepsy Behav. 2004;5:677–86).
Dr. Frey said that probably the best study to date addressing the question of mental decline in patients with uncontrolled epilepsy involved 147 adults with a mean age in their early 30s at baseline with surgically and 102 with medically managed temporal lobe epilepsy evaluated longitudinally at the University of Bonn (Germany).
Neuropsychologic testing conducted at baseline and at 1, 2, and 10 years' follow-up showed progressive cognitive loss, particularly in memory, in those patients with continued seizures despite surgery or medical management. Surgery, whether successful or not, caused cognitive deficits in the short run, but these deficits were often reversed in those patients who became seizure free (Ann. Neurol. 2003;54:425–32). Seizures stop in some patients, who also may regain the deficits caused by surgery. A few patients still have seizures, progressive cognitive loss, and acceleration of the deficits due to surgery, she explained.