Surgery versus medical treatment in temporal lobe epilepsy: insights from 25 years of patient care

Abstract

Temporal lobe epilepsy (TLE) profoundly affects cognitive functions, psychiatric health, and quality of life (QoL). This cross-sectional observational study examined these aspects in 65 TLE patients treated with either epilepsy surgery (35 patients) or anti-seizure medications (30 patients), with a mean epilepsy duration of 24.6 ± 10.9 years. Long-term differences in cognitive and psychiatric outcomes between the two treatment approaches, as well as the influence of seizure persistence and personality traits on decisions regarding surgery, were also investigated. Methods Patients underwent standardized assessments, including neuropsychological tests, structured psychiatric interviews, and the Quality of Life in Epilepsy Inventory-89 QoL inventory. Results showed that seizure freedom was achieved in 65% of surgically treated patients and 16% of medically treated patients (p <0.001). Postoperative seizure freedom correlated with improved attention and verbal fluency (p <0.050), while cognitive recovery was observed in 17 to 57% of surgical patients across various domains. Long-term memory deficits were present in 86% of the medical group and 74% of the surgical group, with no differences in seizure freedom rates between post-surgical patients with stable versus declining memory functions. Results Visual memory and attention emerged as predictors of better QoL (p <0.001, p <0.050). Psychiatric comorbidities were comparable between groups (46% medical, 37% surgical). Seizure-free patients had higher QoL scores (p = 0.001). Although surgical patients showed better scores in emotional well-being, seizure worry, and medication effects (p <0.050), overall QoL scores were similar. Depression and anxiety were associated with lower QoL (p ≤0.010). Conclusion In conclusion, surgery offers superior seizure control in TLE. Postoperative seizure freedom is linked to cognitive improvements and better QoL indicators. Seizure freedom remains a critical determinant of long-term outcomes. © 2026 Georg Thieme Verlag. All rights reserved.