The Advantage of Early Epilepsy Surgery in Drug-Sensitive Patients

Originally published in Epilepsia

Surgical intervention is frequently considered for drug-resistant focal structural epilepsy. However, the impact of early surgery on seizure control, cognitive performance, and quality of life (QoL) in drug-sensitive (DS) and drug-resistant (DR) patients remains incompletely characterized.

Researchers conducted a prospective–retrospective study of 214 patients under the age of six with focal structural epilepsy stratified as DS and DR patients undergoing surgery, and drug-resistant patients on pharmacological treatment (DRT).

Cognitive function, including language, verbal and visuospatial memory, attention/executive functions, as well as quality of life, was assessed at baseline and 1-year follow-up in patient subgroups. The DS patients demonstrated superior rates of complete seizure freedom (86%) compared with DR patients (69%).

At baseline, DS patients exhibited significantly fewer cognitive deficits compared with DR and DRT patients. At the 1-year follow-up, no significant changes in neuropsychological performance were observed in any group, although a mild decline in verbal and/or visuospatial memory performance was observed in DRT patients. In a subset of patients at baseline, DR and DRT patients reported significantly worse overall subjective QoL compared with DS patients.

Longitudinal analysis revealed significant improvements in QoL among surgically treated patients. Early epilepsy surgery in symptomatic focal epilepsy yields excellent seizure outcomes, particularly in DS patients.

Preservation of cognitive function and QoL, together with the stability of these measures after surgery, suggests that timely surgery may help prevent deterioration in cognitive and psychosocial functioning. These findings support early referral for surgical evaluation in selected patients and highlight the need for larger studies with extended follow-up to confirm surgical outcome, long-term neuropsychological, and patient-reported benefits.

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