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Early versus late surgery for intractable seizures
1Department of Neurology, and Brain Research Institute, UCLA School of Medicine, Reed Neurological Research Center, Los Angeles, CA 90095-1769, USA.
Abstract:
Certain drug-resistant epilepsies are highly responsive to surgery. Dr. Engel argues that there is no need to pursue exhaustive drug trials with these patients. If the first-line anticonvulsants fail, they should be referred directly to an epilepsy center and considered for surgical treatment.
Insights
For drug-resistant epilepsies highly responsive to surgery, exhaustive drug trials are unnecessary. Early referral to epilepsy centers for surgical consideration is recommended if initial anticonvulsant therapies fail.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Drug-resistant epilepsies represent a significant clinical challenge.
- Certain epilepsy syndromes demonstrate high surgical candidacy and efficacy.
Purpose of the Study:
- To advocate for a paradigm shift in managing specific drug-resistant epilepsies.
- To propose direct surgical evaluation following failure of first-line anticonvulsant therapy.
Main Methods:
- This is an opinion piece based on clinical expertise and review of existing literature.
- It does not involve new patient data or experimental procedures.
Main Results:
- Patients with specific drug-resistant epilepsies often have favorable surgical outcomes.
- Prolonged trials of multiple anticonvulsants may delay definitive treatment and negatively impact quality of life.
Conclusions:
- Early surgical assessment should be considered for patients with drug-resistant epilepsies.
- Referral to specialized epilepsy centers facilitates timely surgical evaluation and treatment.