Long-Term Seizure Outcome and Antiepileptic Drug Treatment in Surgically Treated Temporal Lobe Epilepsy Patients: A Controlled Study


Address correspondence and reprint requests to Dr. C. G. Bien at University of Bonn, Department of Epileptology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. E-mail: c.bien@uni-bonn.de


Summary:  Purpose: To evaluate the long-term impact of surgical treatment on seizure outcome and antiepileptic drug (AED) use in patients with pharmacoresistant temporal lobe epilepsy (TLE).

Methods: Comparison of seizure outcome and AED us in operated-on TLE patients (n = 148) and nonsurgically treated TLE patients (n = 94) at a baseline visit and a follow-up visit after a mean period of 4.8 years.

Results: At follow-up, 44.6% of the surgical patients and 4.3% of the nonsurgical patients had been continuously seizure- free since the baseline visit (including the immediate postoperative period). A further 17.6% of the operated-on and 3.2% of the not operated-on patients had been seizure-free for at least the previous year; 37.8% of the surgical and 92.5% of the nonsurgical patients had had seizures during the previous 12 months (p < 0.001). Of the surgical patients, 8.8% versus none of the nonsurgical patients were AED free at follow-up; 55.4% versus 20.2% were receiving monotherapy, and 35.8% versus 79.8% were receiving polytherapy (p < 0.001). Mean number of AEDs and mean change in number of AEDs were significantly more favorable in operated-on than in non–operated-on patients. Further subgroup analysis revealed that not only the continuously seizure-free surgical patients, but also the operated-on patients with ongoing seizures took fewer AEDs than their respective non–operated-on counterparts.

Conclusions: This controlled study for the first time provides comprehensive information on long-term seizure outcome and AED use in surgical TLE patients. It shows a more favorable seizure outcome and AED use in the surgically treated patients. The latter holds true even for the not seizure-free patient subgroup.