After surgical lobotomy, incapacitation, apathy and irresponsibility are the rule rather than exception.

EARLY SURGICAL THERAPY FOR DRUG RESISTANT TEMPORAL LOBE EPILEPSY: A RANDOMIZED TRIAL

Joseph Sirven, MD

In the March 7th issue of the Journal of the American Medical Association, Doctors Engle and a group of investigators from across the nation reported results from the ERSET trial, which is the Early Surgical Therapy for Drug Resistant Temporal Lobe Epilepsy. In this study, which was a multicenter controlled parallel group clinical trial performed at 16 U.S. epilepsy surgery centers; 38 participants, 18 men and 20 women aged more than 12 years, had mesiotemporal lobe epilepsy and disabling seizures for no more than 2 consecutive years following adequate trials of 2 brand name antiepileptic drugs. Eligibility for anterior mesiotemporal resection was based on a standardized presurgical evaluation protocol. Individuals were randomized to either continue medication treatment or to undergo surgery and were observed for 2 years. The planned enrollment was 200 and the trial was halted early due to the few number of patients that were enrolled into the trial.

The main item that was being evaluated was whether seizure freedom or seizure cure was better in the group that was treated with surgery versus those treated with continued medication.

Of the 23 participants in the continued medication group, there were no patients who were seizure-free versus 11 of the 15 in the surgical group at 2 years of follow-up. The effect of surgery on quality of life was significant. Memory decline occurred in only 4 patients after surgery consistent with rates seen elsewhere. Side-effects included transient neurological deficits attributed to MRI identified stroke in 1 patient that had surgery and 3 cases of status epilepticus in the group treated with seizures.

The investigators concluded that patients with mesiotemporal lobe epilepsy that surgery resulted in seizure freedom rates at 2 years compared to just treatment with medications alone. Given the early termination of the trial, the results should be interpreted with some caution.

This study is important for 2 primary issues. One, it further underscores the point that surgery is a better option for medical management than ongoing treatment with medications for people who have drug resistant temporal lobe epilepsy. The other part that is important here is the fact that this trial terminated early due to poor enrollment. This study should be taken as a model of what can happen if individuals choose not to proceed with participating in research trials. Important questions that can have significant implications for individuals with epilepsy may not be answered if people choose not to enroll. This study is important because of the fact that it helps again, even in small numbers, shows that we can find important answers to big questions, but again, enrollment in a research trial should be a goal for any individual with seizures in order for them to take control of how to best handle this terrible condition.

by Joseph I. Sirven, MD
Editor-in-Chief, epilepsy.com
Last Reviewed: 5/9/2012

Jan Johnsson’s comment:

After surgical lobotomy, incapacitation, apathy and irresponsibility are the rule rather than exception. (Wikipedia)

When I read reports from investigators, like the one above, that lobotomy surgery (now labeled anterior mesiotemporal resection) is a better option for medical management for people who have drugresistant temporal lobe epilepsy, I feel privileged, having met a modern neurologist like David Ingvar and having had access to Primal Therapy. I got epilepsy about a decade after the Nobel price!!!!!!, which in 1949, was given to the Portuguese António Egas Moniz who developed the technique. If I had lived in Denmark, less than 50 miles from my Swedish address, the risk that I had been maltreated, by the neurologist I met in Roskilde, could have been overwhelming.

I am almost certain that none of the surgeons who surgically lobotomize epileptics do it with bad intentions. However, just knowing that there is a risk that a single patient becomes irreversibly mistreated, without first obtaining a modern comprehensive holistic (including above all: therapy according to the Primal Principle) treatment. In addition, I estimate that the chances are that  pressured neurologists, of impatience, take the decision to surgically lobotomize a desperate and anxious epileptic.  Medication, as in my case, is necessary, and has the advantage that the brain is physiologically intact and can regain its function if therapy treatment according to the “Evolution In Reverse/Primal Therapy” can be applied.

Furthermore, the knowledge that Psychogenic Non Epileptic Seizures often are misdiagnosed (10-40%!) increases the reason to be extremely careful with the lobotomy procedure. The PNES is the kind of epilepsy that has the best potential to be cured with skilled Primal Therapy treatment. They can, with patience, be free from seizures, anxiety and medication. I hope one day in the Epilepsy Therapy blog to read about the result of epileptics with PNES being treated with Primal Therapy according to the Evolution In Reverse principle. It is nature’s own way; however, it has to be done with skill and with adequate guidance.

Jan Johnsson

PS