Nevertheless, the sample size in this study "was too small to permit a definitive conclusion that early surgery does not present a greater risk for cognitive disturbances than continued pharmacotherapy," they added.
Overall, the ERSET results "reinforce the view that surgery soon after failure of two antiepileptic drug trials offers the best chance of preventing a lifetime of disability," Dr. Engel and his colleagues said.
The findings also remind clinicians that "all patients with epilepsy should be referred to an epilepsy center as soon as trials of 2 antiepileptic drugs fail, and surgery should be performed," they added.
The ERSET study was supported by the National Institute of Neurological Disorders and Stroke and the National Institutes of Health. Several of the authors reported receiving consultancy fees, lecture or speakers bureau fees, or travel expense fees from manufacturers of devices and drugs to treat epilepsy.