A study at Sahlgrenska Academy has found that epilepsy surgery is a safe, effective and low-risk procedure. Nevertheless, few Swedes have the operation, and those who are interested may have to wait a long time for presurgical counseling.
The study at Sahlgrenska Academy was based on the Swedish National Epilepsy Surgery Register, which includes all cases since 1990. The researchers reviewed data for the 865 patients who were operated on at Sweden's six epilepsy surgery clinics from 1996 to 2010.
The purpose of surgery is to enable a person with severe epilepsy to be free of seizures or to reduce their frequency to the point that (s)he can enjoy better quality of life.
Only 3% (25) of the patients suffered lasting complications. A comparison with a previous study showed that the complication rate had trended downward.
The Gothenburg study is one of many that have demonstrated the safety and efficacy of epilepsy surgery. A long-term follow-up study in 2013 based on the Swedish National Epilepsy Surgery Register found that more than 60% of adults were free of seizures 5-10 years after surgery.
20 year waiting line
Despite the encouraging data, only 50-60 procedures are performed in Sweden every year. Studies show that it takes an average of 20 years for a patient with treatment-resistant epilepsy to be referred for presurgical counseling.
"One possible reason that it takes so long is that doctors may erroneously believe that surgery is a high-risk procedure," says Johan Bjellvi, a researcher at Sahlgrenska Academy. "Our study has made an important contribution by demonstrating that the risk of complications is very low."
Another problem is that many patients do not even know that surgery is an option.
The Gothenburg epilepsy surgery team is participating in an EU project to raise awareness and increase the availability of these procedures throughout Europe. One goal is to develop a new classification system for complications of epilepsy surgery.
"If we are going to further minimize the risk of operating, the potential adverse effects must be described in a uniform manner," Dr. Bjellvi says. "The EU project is designing a website for use by both doctors and patients in 17 countries."
Epilepsy manifests as seizures, with or without causing convulsions or affecting consciousness. Seizures are due to transient disturbances of the brain's neural electrical impulses. The cause may be temporary or permanent brain damage but cannot always be determined. Approximately 1% of Swedes are predisposed to experience recurring epileptic seizures. Both drugs and surgical methods are available to relieve the symptoms.
The purpose of surgery is to enable the patient to be free of seizures, to minimize their frequency or to reduce their severity by preventing involvement of larger areas of the brain. Many different procedures are available. Anterior temporal lobectomy is the most common. The purpose of certain other procedures is to limit the diffusion pathways of epileptic activity.