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June 20, 2012

Treatment of Refractory Mesial Temporal Lobe Epilepsy—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California (Dr Engel; engel@ucla.edu); and University of Rochester, Rochester, New York (Drs McDermott and Langfitt).

JAMA. 2012;307(23):2483-2485. doi:10.1001/jama.2012.4991

In Reply: We appreciate the concern of Dr Kieling and colleagues regarding the small number of participants in ERSET. Our original plan was to make HRQOL the primary outcome measure, but we changed this to seizure freedom at the request of the National Institutes of Health review panel prior to approval for funding. Nevertheless, we believe our data support a benefit of surgery on HRQOL. Although the effect at 24 months did not reach statistical significance based on the primary intention-to-treat analysis (P = .08), significant differences were found at all earlier time points (P < .009) and at 24 months when postsurgery data from participants in the medical group who received surgery were excluded. The observed effects on secondary outcomes such as driving and socialization further justify a conclusion that early surgery results in psychosocial benefits relative to continued medical management.