Surgery for epilepsy is usually seen as a last resort for patients when medications do not work, and it is often delayed for many years after the failure of drug treatment. Now a randomized, controlled trial suggests that surgery as soon as possible after the failure of two antiepileptic drugs is a significantly better approach than continued medical care.

Previous studies have shown that patients referred for surgery have had epilepsy for an average of 22 years, and are referred on average more than 10 years after the use of two drugs has failed to stop the seizures.

People with continued seizures are at increased risk for drowning and other accidents, depression, progressive loss of memory, and, in younger people, a failure to develop vocational and social skills. Their risk of death is 10 times as high as that of the general population.

Researchers studied a group of 38 epilepsy patients, randomly assigning 15 to brain surgery and 23 to continued medical treatment. The surgery involves the removal of a piece of tissue about the size of a walnut from the temporal lobe, the part of the brain just above the ear. The surgery has been performed for many years, but the institution of high-resolution M.R.I. and microsurgical techniques have greatly improved its safety and efficacy.

The patients in both groups were similar in age, duration of epilepsy, the number of antiepileptic drugs used and the number of seizures they had had. All had been taking drugs for one to two years without relief. The participants were seen at the study site every three months for two years after the start of the study. A group of specialists who did not know which patients had had surgery evaluated them for seizure type and severity as recorded in patient diaries. The study appears in the March 7 issue of The Journal of the American Medical Association.

None of the 23 patients in the medication group and 11 of 15 in the surgical group were free of seizures during the second year of follow-up. Almost all of the surgical patients continued their drug regimen after their operations, which is the standard approach. After that point, if there are no seizures, patients can taper off the medicine.

Delaying surgery can be a serious problem, said Dr. Jerome Engel Jr., the lead author of the study and the Jonathan Sinay professor of neurology at the University of California, Los Angeles. “When they’re operated on 22 years after onset, we can stop the seizures, but we can’t rehabilitate them,” he said. “If you’re going to do surgery, you should do it early, before the adverse consequences pile up and become irreversible.”

Other neurologists were impressed with the study’s execution and results. “The statistical difference was marked, even with a small number of patients, which tells you that the magnitude of the effect is huge,” said Dr. Derek J. Chong, an assistant professor of neurology at Columbia University Medical Center, who was not involved in the study. “Now we see that you don’t need hundreds of patients to find this result.”

Epilepsy affects 0.5 percent to 1 percent of the population, Dr. Engel said, but fewer than 1 percent of patients with uncontrolled epilepsy are ever referred to centers specializing in treatment of the disease. Dr. Engel said that epilepsy does not get the media attention and dollars devoted to other medical conditions.

“According to the World Health Organization, the global burden of epilepsy is the same as that of breast or lung cancer,” he said. “It’s a major health burden, more common than muscular dystrophy, Parkinson’s and multiple sclerosis put together. But there’s no Jerry Lewis to do a telethon.

“Leprosy has been destigmatized. Cancer has been destigmatized. Epilepsy hasn’t been.”