Speakers - NWC 2024

Abstract

The FDA has approved more than 20 new anti-seizure medications in the past three decades; however, epilepsy remains drug-resistant in up to 40% of patients. The probability of achieving seizure freedom declines rapidly after two adequate doses of anti-seizure medication, and early referral for surgical therapy should be considered. Evidence has demonstrated the superiority of resective surgery compared to medical therapy for seizure control in patients with drug-resistant epilepsy. If two well-chosen and tolerated medication trials don’t achieve seizure control, referral to a comprehensive epilepsy center for a pre-surgical workup is appropriate. A longitudinal prospective study that included patients who underwent epilepsy surgery between 2014 and 2019 was done in 2021. A total of 148 adult patients were included. Post-surgical outcomes were reported according to the Engel score, and patients were classified into two groups: seizure-free (SF) and not seizure-free (NSF). The Seizure outcome was reported in 86.5% of patients, and antiepileptic drugs (AEDs) were reduced or discontinued in 45.9%; moreover, surgical resection is more successful for temporal epilepsy, and surgery for frontal and parietal lob epilepsy is less effective. Also, lesional epilepsy, as determined by MRI or pathology, is more likely to result in seizure freedom than non-lesional.