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December 3, 2008

Surgical Treatment for Epilepsy: Too Little, Too Late?

Author Affiliations

Author Affiliations: Departments of Neurology, Neurobiology, and Psychiatry and Biobehavioral Sciences, and the Brain Research Institute, David Geffen School of Medicine at University of California, Los Angeles.

JAMA. 2008;300(21):2548-2550. doi:10.1001/jama.2008.756

Epilepsy is one of the most common serious neurological conditions. According to a study by the World Health Organization, epilepsy accounts for 1% of the global burden of disease based on disability-adjusted life-years (DALYs), productive years lost due to disability or premature death.1 This is equivalent to lung cancer in men and breast cancer in women. Among primary disorders of the brain, epilepsy ranks with depression and other affective disorders, Alzheimer disease and other dementias, and substance abuse. Of the world's population, 0.5% to 1.0% has active epilepsy, and pharmacotherapy is unsuccessful in controlling seizures in 20% to 40% of patients.2 In the United States, 80% of the cost of epilepsy is attributable to patients with medically intractable seizures.3 Temporal lobe epilepsy is the most common cause of pharmacoresistant seizures4 and may constitute half or more of the patients in the United States with medically intractable epilepsy.5 On the other hand, temporal lobe epilepsy is the form of epilepsy most easily and effectively treated with surgery; 60% to 90% of patients can expect to become free of disabling seizures postoperatively.6-8 Appropriately applied surgical treatment, therefore, is crucial for reducing the health burden represented by epilepsy.