Doctors should recommend surgery for epilepsy patients as early as possible, before their symptoms affect brain function and quality of life, according to research in Sweden.
A key finding was that the earlier the surgery, the better chance the patient has of becoming symptom-free.
Anna Edelvik, a doctoral student at the University of Gothenburg, published the research in her dissertation, “Long-Term Outcomes Of Epilepsy Surgery — Prospective Studies Regarding Seizures, Employment And Quality Of Life.”
Epilepsy is the most common chronic neurological disease in Sweden, affecting an estimated 60,000 people. Medication is unable to prevent seizures in one of three patients, making surgery the only other option.
If seizures occur in a limited area of the brain — that is, if they are focal seizures — surgery can be a good option.
“We try to locate the origin of the seizures as precisely as possible, and determine the proximity to areas of vital functional importance,” Edelvik said in a news release. “It’s important to be able to give good information to the patients about possible risks and benefits before making a decision to operate or not.”
She said a third of epilepsy patients who have surgery are children, and the percentage is rising, which doctors consider a good sign.
But the average time until surgery in adults is 20 years. And doctors are often unable to tell which patients could benefit, which can further delay an operation.
Fifty-eight percent of epilepsy patients who have had surgery became seizure-free in five to 10 years, while only 17 percent of those with no surgery became seizure-free, Edelvik discovered. The longer a patient had epilepsy, the less chance they had of becoming seizure-free after surgery, she added.
A study dealing with the number of post-surgery patients holding jobs backed up Edelvik’s contention that the sooner an operation, the better. It found that the earlier the surgery, the more chance a person has of working afterward.
“The highest number of persons in full-time employment at long-term was found among those who worked full-time before surgery, but even if they dropped out of the labor market before surgery, about one third of the persons who were seizure-free had full-time employment after ten to 15 years,” Edelvik said. “It’s important to identify the patients as early as possible before the epilepsy has had too large of an impact.”
The results were in line with previous studies of epilepsy patients’ quality of life. Patients who had not had surgery had lower quality-of-life scores than patients who had the surgery and healthy controls, according to the research.
Epilepsy patients “want to have a job and a family like everyone else, but that doesn’t happen just by becoming seizure-free,” Edelvik said. “Even if the whole lifestyle situation doesn’t change, many would in any case benefit from being examined or evaluated for epilepsy surgery earlier.”