Fall 2003 Volume 16, Number 2	Surgery: When's the Best Time?
	Say you have a low risk technique that could profoundly help up to half of this country's epilepsy patients, curing many. Wouldn't you put money into proving its worth? Yes, say NIH higher-ups, who're now spending $30 million-a first-on the Early Randomized Surgical Epilepsy Trial. Called ERSET, the multicenter study will follow 200 patients who still have seizures despite two years (or less) of good efforts with two or more anti-epileptic drugs. Half of those signing on will undergo surgery to remove trigger tissue in the brain. The rest get the best drug-based care available. Neurologist Gregory Krauss, M.D., has his hopes on the surgery.
"Surgery for epilepsy's come into its own in the last decade," he says. "We've had many patients whose lives have been turned around by it." Hopkins performs about one procedure a week, with satisfying results. But Krauss shakes his head at physicians who make surgery a last resort. "Every neurologist knows patients who've been disabled by epilepsy for years. Surgery can stop their seizures, but they neither return to work nor lead normal social lives because they've been hobbled so long by the disease." The real question, says Krauss, is whether early surgery-coming less than two years after onset of uncontrolled seizures-makes a difference. "Clearly, ERSET will tell how surgery compares with medication in reducing seizures. But by monitoring quality of life, socialization and psychological outcomes, it should also see if we can block patients' slip into a chronic disabled state." Also, because years of seizures can cause brain atrophy and lowered metabolism, ERSET will check for such changes in the brain via MRI and PET scans. The trial recruits epilepsy patients whose typical temporal lobe epilepsy stems from scarring in the hippocampus. They're optimal patients for surgery because scarring is easy to spot with MRI. Then removal of affected tissue is straightforward. "I feel sure," says Krauss, "that I'll be able to tell every doctor: If you have patients with these uncontrolled seizures, you can save them from disability." For information, call 410-955-2822.