News | 27 August 2020

Nearly three-quarters of patients seizure-free after epilepsy surgery

Operating sooner brings better treatment results

A large-scale European study on the effectiveness of epilepsy surgery convincingly demonstrates the success of such interventions. These results help in deciding whether an operation is useful in the case of epilepsy. The findings also underpin the idea that operating as quickly as possible improves the outcome. This study, in which Maastricht UMC+ has participated together with Kempenhaeghe (under the name Academic Centre for Epileptology), was recently published in the scientific journal Lancet Neurology.

iStockiStockThe European Epilepsy Brain Bank study (for which Maastricht UMC+/Kempenhaeghe also supplied data) shows that 72 per cent of patients with epilepsy are seizure-free one year after the operation. After two years, the proportion is 68 per cent and after five years it is 66 per cent. The study looked at a total of 9147 patients who had had surgery between 2000 and 2012.

Benefits
In the past, patients were only operated on if medication did not help them. Nowadays, the decision is sometimes made more quickly to perform surgery. The benefits of surgery often outweigh the limited risks. An additional benefit is that chronic use of medication can then be avoided, and therefore also the possible side effects associated with drugs. A second reason for operating earlier is that if a patient has had epilepsy for a shorter time, this increases the likelihood of a successful operation. The new research results support that policy.

Different causes
In epilepsy surgery, the source of the epilepsy is removed from the brain. This can only be done if it does not result in the loss of any important brain functions. The study therefore also looked at the differences in outcomes with different causes of epilepsy. It showed that 78 per cent of patients who had epilepsy as a result of a tumour were seizure-free after surgery. For epilepsy patients with specific congenital disorders of the cerebral cortex, the success rate was significantly lower at 50 per cent. This means that the research results can be included in deliberations on how to treat epilepsy.

Operating sooner
In addition, the study also shows that the earlier the operation, the higher the chance of success. For example, for epilepsy that is the result of a vascular injury, the probability of becoming seizure-free after an operation is 85 per cent if you have surgery within one year. If you only have surgery after 20 years, however, that probability is reduced to 70 per cent. With early surgery, patients therefore need medication for a shorter time.

Tailor-made treatment
"The conclusions drawn from the research are extremely valuable," says neurosurgeon Dr Olaf Schijns of Maastricht UMC+. "They underline the effectiveness of epilepsy surgery and the importance of offering every patient tailor-made treatment that is appropriate to his or her situation. For that reason, this is always the basis of the multidisciplinary discussions between the experts of Maastricht UMC+ and Kempenhaeghe." Neurologist Dr Albert Colon of Kempenhaeghe adds: "This makes even clearer the importance of early referral for pre-surgery analysis, both from peripheral hospitals and internally. Our task is to highlight this more strongly."

The European Epilepsy Brain Bank study is a European collaboration and part of the European Reference Network Epicare. It has studied data of more than 9000 epilepsy patients from 37 centres in 18 countries.