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Neurology


Answer 5
  1. Refer to an epilepsy surgery center. Referral to an epilepsy surgery center should be considered as soon as first-line antiepileptic therapies become ineffective.3 Only 3% of patients with refractory seizures on 1 drug become seizure-free when taking 2 or more drugs,3 highlighting that continued attempts to treat patients with more drugs or combinations of drugs may not be beneficial. In mesial temporal lobe epilepsy, surgery is superior to prolonged medical therapy. In a study by Wiebe et al,4 the cumulative proportion of patients who were free of seizures that impaired awareness at 1 year was 58% in the surgical group and 8% in the medical group (P < 0.001). Patients who received surgery had fewer seizures that impaired awareness and had a significantly better quality of life as compared with patients who received antiepileptic drugs (P < 0.001 for both comparisons).4

    REFERENCES
    3. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med 2000;342:314–9.

    4. Wiebe S, Blume WT, Girvin JP, Eliasziw M; Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group. A randomized control trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001;345:311–8.

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