Long-term seizure outcome and antiepileptic drug treatment in surgically treated temporal lobe epilepsy patients: A controlled study

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.