People with nonlesional neocortical epilepsy could benefit from brain surgery and become seizure-free in the long term according to a study published in the scientific journal JAMA Neurology.Dr Dong Wook Kim and colleagues explored factors that might help select people with nonlesional neocortical epilepsy who are most likely to benefit from surgery. The researchers analysed data from 109 people, aged seven to 56,with drug resistant neocortical epilepsy (which arises from the surface of the brain), and who attended Seoul National University Hospital in South Korea between 1995 and 2005.All of the patients had failed to respond to treatment with at least two antiepileptic drugs (AEDs) but none had abnormalities or lesions in the brain identifiable by MRI (hence “nonlesional”). Nevertheless, all of the patients underwent surgery to remove the part of the brain that their doctors believed to be responsible for their seizures.One year after surgery, 59 of the 109 patients (54%) were completely free from seizures and a further 37 patients (34%)had notable reductions in seizure frequencybut without achieving complete remission.All of the patients, except one, were then followed up clinically for at least 10 years, and some for as long as 21 years after surgery. A total of 64 patients (59.3%) were seizure-free and 33 patients (30.6%) had a lower seizure frequency at their last clinical follow-up, suggesting that the effectiveness of surgery was maintained in the longer-term.Although the chance of achieving seizure freedom was lower than would be expected for people with mesial temporal lobe epilepsy or lesional neocortical epilepsy, according to the authors “it was notable that nearly 90% of patients benefited from resection surgery for nonlesional neocortical epilepsy.”People with nonlesional neocortical epilepsy are not usually considered optimal candidates for surgery, but recent studies have shown that a greater proportion of people with this type of epilepsy are being offered surgical intervention. This study supports the benefits of surgery in those patients but further research is needed to confirm the results presented here.Author: Dr Özge ÖzkayaClick here for more articles about other treatments for epilepsy.