Does surgery prevent worsening of epilepsy?


To the Editors:

Sarkis et al. (2012) reported worsening of seizures in 18.5% of their surgical patients and attributed the worsening to extratemporal resections, incomplete resections, and multiple recorded ictal patterns. An additional explanation may be that surgery could not prevent a worsening pattern of epilepsy in the natural history of epilepsy that would have occurred without surgery. A worsening pattern of epilepsy—with uncontrolled seizures after initial remission—has been reported in 14% of patients with new-onset epilepsy during long-term observations in a nonsurgical series of childhood-onset epilepsy (Sillanpää & Schmidt, 2006). In addition, Geerts et al. (2012) recently noted that antiepileptic drug treatment had only a small effect on patterns of intractability in childhood-onset epilepsy. Given that the study by Sarkis et al. (2012) did not report how many of their patients had a stable pattern of drug-resistant epilepsy and how many had a history of worsening epilepsy prior to surgery, further work is needed to assess the effect of surgery, if any, on these patterns of the natural history of medically treated epilepsy.


We thank Ada Geerts for critical input to an earlier version of the manuscript.


 Dieter Schmidt has received speaker’s or consultancy fees from Novartis, UCB Pharma, and Viropharm. Matti Sillanpää has nothing to disclose. We have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.