***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Sixty-three patients ( 32 women , 31 men ) , chronically treated with carbamazepine , phenytoin , valproate and /or phenobarbital , were investigated . Mean age at manifestation of epilepsy was 16.4 years ; mean age at onset of documentation of seizure frequency was 33.7 years ; mean duration of follow-up was 104.8 months ; mean number of documented seizures per patient was 313.2 . A statistical analysis of seizure diaries was performed . For each day the entries were the number of seizures per day . Linear trends , the amount of variance of the seizure frequency compared to r and omly distributed events , were computed with the result ing coefficients fitting a general linear regression model . Non-r and om aggregations ( clusters ) were search ed for as well as gaps of seizure manifestation . A similar number of patients exhibited a decrease ( 30 % ) or increase ( 29 % ) of seizure frequency during the course of epilepsy . The variance of the daily seizure frequency was in most patients ( 78 % ) significantly higher or lower ( 5 % ) than corresponding r and om distributions . The coupling coefficient to the day before was significantly larger than zero ( indicating seizure clustering ) in 57 % of patients . Significant rhythmic components in seizure profiles ( quasi-weekly or quasi-monthly ) were found in 31 patients ( both male and female ) . Periods of increased seizure frequency ( clusters ) manifested in 62 % of patients ; seizure gaps of at least 1 year occurred in 29 patients followed by seizure relapses in 20 patients . In conclusion , there is no evidence for a unique type of course in chronic focal epilepsy in patients on antiepileptic drugs The purpose of this study was to investigate which areas of quality of life ( QOL ) change after  epilepsy surgery  and generate QOL data specific to the Lebanese population . The QOL of 20 consecutive patients 1 year after surgery was compared ( using the ESI-55 scale ) with that of 20 matched patients who underwent the same presurgical evaluation , but no surgery .  Overall QOL improved in both groups , but was greater in the surgery group ( 85 % seizure free as compared to 0 % in nonsurgery group ) . Significant differences were noted within the " well-being " domain including health perception ( 5/9 items ) , energy-fatigue ( 2/4 ) , and emotional well-being ( 2/5 ) . Differences were less common in the " functioning " domain including physical ( 1/10 items ) , social ( 1/2 ) , and cognitive ( 0/5 ) functioning scales , and in the role limitation domain ( 1/17 items ) . Our patients experienced , 1 year after epilepsy surgery , improvements similar to those reported in Western population s after a similar period : they had marked improvements in overall QOL , health perception , well-being , and cognitive functioning areas . They had less remarkable improvements in social functioning and role limitation areas OBJECTIVE To compare the efficacy of medical and surgical treatment for refractory mesial temporal lobe epilepsy associated with hippocampal sclerosis ( MTLE ) . METHODS A prospect i ve controlled non-r and omized study of 26 patients with MTLE who underwent surgical treatment and 75 patients with MTLE who underwent medical treatment between August 2002 and October 2004 . All patients failed to achieve seizure control with at least two first line antiepileptic drugs ( AED )  for partial seizures before entering the study . We used Kaplan-Meier survival analyses as a function of time of seizure recurrence to obtain estimates of 95 % confident interval of seizure freedom and log-rank test to compare the status of seizure control between the two groups . RESULTS The cumulative proportion of patients free of all seizures ( Engel 's class IA ) was higher in the surgical group ( 73 % ) compared to the clinical group ( 12 % ) ( p<0.0001 ) . In the surgical group , 2 of 26 patients ( 7.7 % ) had transient adverse effects and 2 of 26 patients ( 7.7 % ) had a permanent deficit related to the surgical procedure . In the clinical group 7 patients ( 9.3 % ) major adverse events during follow-up , including burns and status epilepticus . CONCLUSIONS Surgical treatment for patients with MTLE who failed to achieve seizure control with two previous AED regimens was more efficient than medical treatment with further trials of AED We conducted a prospect i ve study over 24 months to compare health‐related quality of life in surgically and medically treated patients with intractable temporal lobe epilepsy .  Seizure frequency and health‐related quality of life were assessed in 81 patients before and 6 , 12 , and 24 months after treatment . Using the Epilepsy Surgery Inventory 55 ( ESI‐55 ) , we compared ( 1 ) different seizure outcome groups and ( 2 ) temporal lobectomy with continuing medical management . Follow‐up was satisfactory in 72 patients ( 89 % ) , 51 treated with temporal lobectomy and 21 with no surgery .  Pretreatment seizures and health‐related quality of life were comparable in the two groups . Seizure outcome was significantly better at 6 , 12 , and 24 months after surgery . At 24 months , seizure‐free patients and those with at least a 90 % reduction in seizure frequency reported significant improvements in health‐related quality of life ( on 5 of 10 subscales and overall Epilepsy Surgery Inventory 55 scale ) . Deterioration in quality of life occurred with less than 90 % seizure reduction . Only one Epilepsy Surgery Inventory 55 subscale at 6 months and two subscales at 12 months showed a significant difference . Patients with good seizure outcome experience improved health‐related quality of life after treatment . Since temporal lobectomy results in considerably better seizure control than continued medical management , the findings support surgery as the preferred treatment , although changes in health‐related quality of life may not be evident until the second postoperative year Surgery for intractable epilepsy is a widely used treatment that is not readily assessed by r and omised trials . We evaluated the impact of epilepsy surgery on seizures , medication use , employment , and the quality of life in 248 adults and adolescents consecutively referred to one medical centre between 1974 and 1990 . Outcomes were determined through self-administered question naire and medical record review for 202 surgery and 46 non-surgery patients whose treatment was usually determined by the presence or absence of an epileptogenic focus . Surgery and non-surgery patients differed at baseline only in median monthly seizure frequency ( surgery lower than non-surgery ) . After adjustment for baseline covariates , surgery patients at follow-up had greater decline in average monthly seizure frequency ( -11.9 vs - 1.5 ; difference -10.4 , 95 % CI -20.5 , -0.3 ) and took fewer antiepileptic medications ( average number 1.4 vs 2.0 ; difference -0.67 , 95 % CI -0.94 , -0.40 ) . Although quality -of-life scores were higher ( p < 0.05 ) with surgery on 5 of 11 scales that were administered only at follow-up , there were no significant differences in employment status or prospect ively assessed quality of life . Relative to a non-surgery group , patients treated surgically had better seizure control with less antiepileptic medication . The impact of epilepsy surgery on quality of life and employment needs to be assessed in larger prospect i ve studies PURPOSE A prospect i ve study to investigate health-related quality of life ( HRQOL ) outcome in patients with temporal lobe epilepsy treated with anterior temporal lobectomy ( ATL ) .  METHODS The majority of the patients with medically refractory focal epilepsy had Quality of Life in Epilepsy-89 ( QOLIE-89 ) assessment at the time of prolonged video/EEG monitoring as part of their presurgical evaluation . Thirty-seven patients who were not treated surgically constituted the control group , and 53 patients who underwent ATL made up the surgery group . Both control and surgery groups had  HRQOL assessment  repeated at approximately 1- and 2-year intervals . Repeated measures analysis of variance ( ANOVA ) was used to test for differences between the two groups . RESULTS For the overall score and almost every scale , the surgery group had a higher baseline mean than the control group . Because of this baseline difference , change scores were used in further analysis . The overall score and 10 of 17 scales in QOLIE-89 showed significant HRQOL improvement after ATL , and the improvement was significant relative to score changes of the nonsurgical comparison group . Scores improved in overall QOL , emotional well-being , attention/concentration , language , social isolation , health perception , role limitations -physical , work/drive/social , health discouragement , and seizure worry . For the first five scales , there was group-time interaction ; the improvement was significantly more on the 2-year than on the 1-year follow-up . When the surgery patients were divided into four categories ( class IA- , completely seizure free ; class IA+ , seizure free with aura ; class II , rare seizures ; class III , worthwhile improvement in seizure control ; and class IV , no improvement ) , the improved HRQOL in the surgery group was almost entirely contributed by the class IA- outcome patients who were totally seizure free . The class IA+ patients with continuing aurae and class II/III/IV patients had no significant improvement in their overall HRQOL scores at 1-or 2-year follow-up . CONCLUSIONS Overall score and 10 of the 17 scales of QOLIE-89 significantly improved in patients with medically refractory temporal lobe epilepsy after ATL . For some scales , there was delay in the improvement to manifest . The HRQOL improvement was related to achieving an entirely seizure-free status ( i.e. , no seizures or aurae postoperatively ) Objective : To quantify the response to treatment with antiepileptic drugs ( AEDs ) as a function of the past treatment history and identify additional prognostic factors for predicting the response to newly administered AED treatments . Methods : A cohort of 478 consecutive patients who received newly administered AED treatments between January 1999 and December 2004 and were followed prospect ively for 1.5 to 7.5 years in a single epilepsy clinic . Results : The response to newly administered AED treatments was highly dependent on the past treatment history . The seizure-free rates decreased from 61.8 % for the first AED to 41.7 % , 16.6 % , and 0 % after one , two to five , and six to seven past AEDs proved inefficient . This response curve corresponded to a mono-exponential function with a maximal response of 61.8 % and half-decay constant of 1.5 AEDs . Likewise the response curve describing a greater than 50 % reduction in seizure frequency corresponded to a mono-exponential function with a maximal response of 85.3 % and half-decay constant of two AEDs . Three additional independent prognostic factors for predicting the response to AEDs were identified : type of epilepsy , duration of epilepsy , and number of seizures in the 3 months prior to AED initiation . Conclusion : Drug resistance is a grade d process that follows a mono-exponential course with a half-decay constant of 1.5 to two antiepileptic drugs ( AEDs ) . Although relative drug-resistant epilepsy can be diagnosed after failure of two past AEDs , absolute drug resistance requires failure of six AEDs , as a significant minority of patients ( 16.6 % ) is rendered seizure-free by addition of newly administered AEDs even after failure of two to five past antiepileptic drugs . GLOSSARY : AED = antiepileptic drug ; CBZ = carbamazepine ; GBP = gabapentin ; LTG = lamotrigine ; TPM = topiramate ; VA = valproic acid BACKGROUND R and omized trials of surgery for epilepsy have not been conducted , because of the difficulties involved in design ing and implementing feasible studies . The lack of data supporting the therapeutic usefulness of surgery precludes making strong recommendations for patients with epilepsy . We conducted a r and omized , controlled trial to assess the efficacy and safety of surgery for temporal-lobe epilepsy . METHODS Eighty patients with temporal-lobe epilepsy were r and omly assigned to surgery ( 40 patients ) or treatment with antiepileptic drugs for one year ( 40 patients ) .  Optimal medical therapy and primary outcomes were assessed by epileptologists who were unaware of the patients ' treatment assignments . The primary outcome was freedom from seizures that impair awareness of self and surroundings . Secondary outcomes were the frequency and severity of seizures , the quality of life , disability , and death . RESULTS At one year , the cumulative proportion of patients who were free of seizures impairing awareness was 58 percent in the surgical group and 8 percent in the medical group ( P<0.001 ) . The patients in the surgical group had fewer seizures impairing awareness and a significantly better quality of life ( P<0.001 for both comparisons ) than the patients in the medical group . Four patients ( 10 percent ) had adverse effects of surgery . One patient in the medical group died . CONCLUSIONS In temporal-lobe epilepsy , surgery is superior to prolonged medical therapy . R and omized trials of surgery for epilepsy are feasible and appear to yield precise 
    Output:
    
The available evidence from mostly nonr and omized observational studies indicates that in appropriately selected patients with drug-resistant temporal lobe epilepsy , the combination of surgery with medical treatment is 4 times as likely as medical treatment alone to achieve freedom from seizures