Medical and surgical treatment of epilepsy

Excerpt

Over the last twenty years considerable progress has been made in the treatment of different forms of epilepsy: new drugs have been established and surgical intervention has been shown to be effective. Several topics, however, still need further evaluation. Progress in three of them will be reported in this month’s Journal Club. The first article reports on a head-to-head comparison of levetiracetam and controlled-release carbamazepine in newly diagnosed epilepsy. This state-of-the-art trial demonstrates similar efficacy with lower withdrawal rates for adverse events in patients treated with levetiracetam. The second study evaluated a very important clinical question: how effective are treatment changes in patients with apparently drug-resistant chronic epilepsy. The authors concluded that “the rather nihilistic view that intractability is inevitable if seizure control is not obtained within a few years of the onset of therapy is incorrect”. The third article deals with the efficacy of temporal lobectomy in patients with medically refractory non-lesional temporal lobe epilepsy. It clearly demonstrates that the extent of resection of the region of hypometabolism on the preoperative FDG-PET is predictive of outcome and that strategies that tailor resection extent to regional hypometabolism are very promising. …