Lost years

In this issue of Neurology , Yoon et al. report excellent long-term outcome among patients who were seizure-free for the first year after resective epilepsy surgery, in spite of conservative outcome measures. For example, patients were counted as surgical failures if they had a single seizure after medication withdrawal, even if they achieved complete seizure control upon restarting antiseizure drugs (ASD); these patients who “failed” epilepsy surgery could have driven to their last follow-up visit and enjoyed the same quality of life as those patients who were seizure-free after surgery. Yoon et al. not only documented excellent seizure-free rates, they also documented years of surgically treatable epilepsy during childhood, adolescence, and young adulthood before referral for surgical evaluation.1 Duration of preoperative epilepsy ≥20 years and age at surgery ≥30 years were associated with an increased risk of recurrence.1 Unfortunately, so few patients had surgery within the first 10 years of their epilepsy that we do not know if earlier intervention would have offered these patients improved …