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A Plan for a Randomized Clinical Trial

Jerome Engel, Jr, MD, PhD

Arch Neurol. 1999;56:1338-1341.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

It is estimated that 20% of patients with epilepsy have seizures that cannot be controlled by antiepileptic drug therapy.^1-2 Approximately half of these patients are potential candidates for surgical treatment.¹ Based on a prevalence of epilepsy in the United States of 0.5% to 1.0%,³ there should be more than 100,000 patients with poorly controlled epilepsy who might benefit from surgical intervention.^{1, 4} Data obtained from an international conference on surgical treatment for the epilepsies held in 1992⁵ indicated that only 1500 therapeutic surgical procedures were performed for epilepsy in the United States in 1990.¹ With increasing interest in epilepsy surgery, this number may have doubled over the past 8 years. Nevertheless, there appears to be an extraordinary underutilization of this effective alternative treatment for a common and seriously disabling neurological disorder. Similar statistics can be found in every industrialized country, and surgical treatment for epilepsy is . . . [Full Text of this Article]

THE PROBLEM

THE EQUIPOISE

There Are Inadequate Data to Determine the Timing of Surgical Intervention

Surgical Treatment Does Not Need to Be a "Last Resort"

Criteria for Early Surgical Intervention Could Be Developed for Specific Surgically Remediable Syndromes

THE STUDY POPULATION

Mesial Temporal Lobe Epilepsy Is the Ideal Syndrome for an RCT to Determine the Timing of Surgical Intervention

Early Surgical Treatment of MTLE Might Prevent Irreversible Disabling Consequences

THE STUDY DESIGN

From the Departments of Neurology and Neurobiology and the Brain Research Institute, University of California, Los Angeles, School of Medicine, Los Angeles.

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