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

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Abstract
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.