• Surgery is better than medical management for improving quality-of-life for refractory epilepsy patients

    Although surgical efficacy for controlling medically intractable seizures has been demonstrated in two randomized controlled trials (Wiebe et al, 2001Engel et al., 2012), its impact on quality of life (QOL) has not been comprehensively evaluated.  Two recently published randomized trials in Epilepsia address this critical shortcoming. Fiest and colleagues reported on 80 refractory focal epilepsy patients randomized to medical treatment or surgery. At 6 months, 56% of patients in the surgical group achieved clinically important and meaningful improvements in QOL indices, compared to 11% in the non-surgical group. In a randomized trial of 112 patients, Ryvlin et al reported that patients who received vagus nerve stimulation therapy also had significant improvements in QOL indices compared to only best medical management. These randomized trials demonstrate that the benefits of epilepsy surgery extend beyond seizure control to improve QOL, and argue for expanding the meaningful use of QOL as an important way of assessing epilepsy surgery results and counseling patients.

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