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Stanford Report, August 6, 2003

Surgical treatment for epileptic seizures studied

By AMY ADAMS

A new epilepsy trial at the medical center will test whether brain surgery should be elevated from a treatment of last resort to a recommended option for those whose seizures can’t be controlled by medication.

"For some people with difficult seizures, surgical treatment is clearly better than medical treatment. The question is when to do the surgery," said Michael Risinger, MD, associate professor of neurology and neurological sciences.

People with epilepsy have a range of drugs to treat their disease, but they are not effective in all people. When at least two drugs aren’t able to prevent seizures, it is unlikely that any drug will be effective, said Risinger. The question at that point is whether to systematically try the roughly 15 available drugs in hope of success or recommend surgery to remove the brain region responsible for the seizures.

"Right now surgery is considered by many as a treatment of last resort," Risinger said. That’s true despite a recent study showing that patients who no longer respond to medication had fewer seizures after surgery compared with those who continued the search for effective drugs. Most people who opt for surgery have been having seizures regularly for more than 15 years, Risinger said.

The new trial, known as the Early Randomized Surgical Epilepsy Trial or ERSET, is a multicenter study sponsored by the National Institutes of Health and led by researchers at UCLA. The trial will fast-track newly drug-resistant epilepsy patients into surgery, skipping the years-long process of trying all available medications.

"The idea is that if you give these people surgery earlier they will have a better outcome," said Lawrence Shuer, professor of neurosurgery. People with uncontrolled epilepsy often face social challenges. They are prevented from driving and may face obstacles holding a job or living an independent life, Shuer said.

During the surgery doctors remove just the region of the brain that’s responsible for triggering seizures. For the type of epilepsy being studied in this trial, called mesial temporal lobe epilepsy, removing this clump of neurons controls seizures in about 75 percent of patients, Shuer said.

Risinger, who will be the neurologist for all Stanford ERSET participants, said that by comparing people who have early surgery with those who remain on drugs, researchers hope to learn whether the risks involved with surgery are balanced out with happier, healthier patients years later.

The ERSET trial is limited to people over age 12 whose epilepsy has not responded to at least two different drugs within the past two years. Patients will be randomly assigned either surgery or state-of-the-art treatment with medications. At the end of two years, participants who received drugs will have the option of surgery. For information on participating in the trial, contact Mimi Callanan at the Stanford Comprehensive Epilepsy Center 725-6648.





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