We conducted a retrospective parallel cohort study comparing surgical and medical treatment for epilepsy. The surgical group contained all 201 patients treated with resective surgery for epilepsy in Norway since the first operation in 1949 until January 1988. The 185 patients in the control group, medically treated only, were closely matched for year of treatment, age at treatment, sex, seizure type, and neurologic deficit before treatment. Between 75 and 95% of the survivors (median 17 years after treatment) completed two questionnaires on their social situation. Although surgical treatment improved the seizure situation (about one-fourth had some neurologic deficit), a considerably smaller long-range influence on different social aspects was observed. There were no significant differences between the two groups in educational status, social pensions, social status, marital status, fertility, dependency in residential situation, the need for aid in daily activities of living (ADL), or the need for being looked after, when we controlled for pretreatment status. In all, 25.3% of the surgically treated patients and 8.5% of the controls were not receiving anti-epileptic drugs (AEDs) at the time of investigation (Mann-Whitney U test, two-tailed p = 0.0011). A considerably higher proportion of the surgically treated (53.2%) than control patients (24.2%) claimed that the treatment had improved their "working ability" (Mann-Whitney U test, two-tailed p less than 0.0001), but this resulted in significant improvements in the actual working situation only for those in regular education or work before treatment (chi 2 = 6.514, p = 0.038).

We conducted a longitudinal self-controlled study of 131 patients aged 4-60 treated with resective surgery for medically uncontrolled partial epilepsy from 1949 to 1988. Using multivariate logistic regression, we showed that pre- and perioperative variables can be used to predict "success" or "failure" of surgical resective treatment in approximately 79% of cases. If the predicted probability is > 0.75 or < 0.25, the model predicts a correct result in 87% of cases. Eight predictive factors emerged with a backward multivariate logistic regression model with the likelihood-ratio (LR) test to exclude variables from the equation: (a) the influence of the surgical team and surgical procedure, (b) the presence of paresis preoperatively, (c) duration of disease, (d) age at treatment, (e) positive neuroradiologic findings in preoperative investigations, (f) preoperative complex partial seizures (CPS), (g) nonepileptic EEG abnormalities, and (h) generalized spike activity in EEG preoperatively. Sex, age at first seizure, area of resection, presence of simple or generalized seizures preoperatively, preoperative seizure frequency, tissue pathology, use of computed tomography/nuclear magnetic resonance (CT/NMR) in preoperative investigations, degree of preoperative neurologic deficit, perioperative electrocorticographic results, and bilateral EEG spikes did not have predictive value in the model.

We conducted a retrospective parallel longitudinal cohort study comparing surgical and medical treatment for epilepsy. The surgical group contained 201 patients treated with resective surgery for epilepsy in Norway since the first operation in 1949 until January 1988. The 185 control group patients treated medically only were closely matched for year of treatment, age at treatment, sex, seizure type, and neurologic deficit before treatment. There was no significant difference in survival between the two groups. The total monthly seizure frequency in the first and second year after operation and last year of registration (median 9 years) was significantly lower in the surgical group than in the control group (Mann-Whitney U test, two-tailed p less than 0.0001). The patterns were similar, with significant differences for subgroups with similar pretreatment status, such as seizure frequency, age, etiology and EEG-focality. Twenty-three and four-tenths percent (n = 40) of the surgically treated, and 2.9% of the controls had contracted neurologic deficits within 2 years after treatment. The difference was significant (chi square = 32.89, p less than 0.0001). Psychosis or permanent psychotic symptoms were reported in 6.7% (n = 11) of the surgically treated patients, and we suspect a higher proportion of psychotic development in the surgical group than in the control group. We conclude that surgical treatment for partial epilepsy is more successful than medical treatment in producing seizure reduction, provided the indications for operation exist. Surgical treatment produces more neurologic deficits than medical treatment (and possibly more psychiatric morbidity), and this factor must be weighed against the reduction in seizure frequency. The two treatments are equal for longterm survival.

After the introduction of levodopa drugs in the late 1960s, the number of thalamotomies fell dramatically world wide. However, as the Parkinsonian tremor proved rather resistant to levodopa treatment, the interest in this operation has been revived. During 1978-86, 51 stereotaxic thalamotomies were performed in 48 patients in our department. Thirty three of these patients had Parkinsonism, nine multiple sclerosis (MS) and the remaining six had various other involuntary movement disorders. The operation was most useful in the Parkinsonian group. Nearly 80% of these patients gained a substantial benefit in their daily lives. Patients with MS were all in advanced stages of the disease, and the operation was tried as a last resort. They had less benefit and more complications from operation than the other patients.