Current Status and Future Objectives of Surgical Therapies for Epilepsy in Japan

Mikuni, Nobuhiro; Usui, Naotaka; Otsubo, Hiroshi; Kawai, Kensuke; Kishima, Haruhiko; Maehara, Taketoshi; Mine, Seiichiro; Yamamoto, Takamichi

doi:10.2176/nmc.st.2021-0230

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…The survey response rate (17.3%) was not high. Based on the annual reports of the Japan Neurosurgical Society, the total number of epilepsy surgery conducted in Japan between 2015 and 2018 was approximately 1200 per year 26 . In this study, a total of 954 epilepsy surgeries in 1 year were reported (Table 2), which corresponds to 80% of the 1200 surgeries nationwide.…”

Section: Discussionmentioning

confidence: 85%

“…Based on the annual reports of the Japan Neurosurgical Society, the total number of epilepsy surgery conducted in Japan between 2015 and 2018 was approximately 1200 per year. 26 In this study, a total of 954 epilepsy surgeries in 1 year were reported (Table 2 ), which corresponds to 80% of the 1200 surgeries nationwide. Besides, since the population of Japan in 2016 was 127 million 27 and the incidence of epilepsy in high‐income countries is 48.86/100 000 person‐year, 1 the estimated number of new cases of epilepsy in Japan is 62 000 per year.…”

Section: Discussionmentioning

confidence: 92%

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Status of epilepsy care delivery and referral in clinics, hospitals, and epilepsy centers in Japan: A nationwide survey

Tokumoto,

Terada,

Kawaguchi

et al. 2023

Epilepsia Open

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ObjectiveCollaboration among medical facilities is crucial to deliver comprehensive epilepsy care to a diverse and large population of people with epilepsy. We conducted a survey among medical facilities of various sizes throughout Japan to investigate the status of epilepsy care delivery, functioning, and referral.MethodsWith the cooperation of the Japan Neurological Society (1428 facilities), Japanese Neurosurgical Society (3489 specialists), and Epilepsy Care Network (948 facilities), a questionnaire was mailed to 5865 locations that provide epilepsy care in Japan. The facilities were classified into clinics (19 beds or less), small hospitals (SH, 20–199 beds), large hospitals (LH, 200 beds or more), and epilepsy centers (EC). The status of epilepsy care delivery, functioning, and referral was compared among the four groups.ResultsResponses were received from 1014 facilities (17.3% response rate). After excluding duplicate responses, 957 facilities were analyzed (394 clinics, 149 SH, 388 LH, 26 EC). EC responded “manageable” in more items of epilepsy care functions in general, especially those related to epilepsy surgery, compared to LH with similar facility size. However, EC responded being less manageable in psychiatric service (61.5%), dietary therapy (46.2%), rehabilitation (53.8%), and patient employment support (61.5%). The percentage of facilities that responded “always able to refer” was highest in clinics (67.6%) and the lowest in EC (40%). Referral difficulties were more commonly encountered in EC, and less common in clinics. In EC, the most common reason for inability to refer was patient or family refusal (64%).SignificanceWe have clarified the epilepsy care delivery, functioning, and referral in facilities of various sizes in Japan. This study highlights the issues of downward referral and patient stagnation in EC, which have not received much attention.Plain Language SummaryA nationwide survey of healthcare facilities ranging in size from small clinics to large hospitals in Japan examined medical care delivery and patient referrals related to epilepsy. Compared to other facilities, epilepsy centers provided a variety of medical services to people with epilepsy but were inadequate in addressing psychiatric symptoms, providing dietary therapy, rehabilitation, and patient employment support. Referrals from epilepsy centers to other medical facilities were often refused by patients and their families. This results in patient crowding at epilepsy centers

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 92%

Status of epilepsy care delivery and referral in clinics, hospitals, and epilepsy centers in Japan: A nationwide survey

Tokumoto,

Terada,

Kawaguchi

et al. 2023

Epilepsia Open

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“…The number of epilepsy surgeries was estimated to be approximately 240 of 100,000 people with medically refractory epilepsy by the 3rd National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data in 2016, 46) which was remarkably small compared to the number in the report for the United States, 44) although Mikuni et al recently reported that the annual number of epilepsy surgeries in Japan increased from 600 cases in 2011 to 1200 cases in 2018. 47) By contrast, use of the SEEG procedure has just started in Japan. The medical fee revision newly regulated the medical fee points for surgical techniques for SEEG in 2020 in Japan.…”

Section: Current Situation In Japan Regarding Seeg and Associated Issuesmentioning

confidence: 99%

Clinical Impacts of Stereotactic Electroencephalography on Epilepsy Surgery and Associated Issues in the Current Situation in Japan

Maesawa

Ishizaki

Mutoh

et al. 2023

Neurol. Med. Chir.(Tokyo)

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Stereotactic electroencephalography (SEEG) is receiving increasing attention as a safe and effective technique in the invasive evaluation for epileptogenic zone (EZ) detection. The main clinical question is whether the use of SEEG truly improves outcomes. Herein, we compared outcomes in our patients after three types of intracranial EEG (iEEG): SEEG, the subdural electrode (SDE), and a combined method using depth and strip electrodes. We present here our preliminary results from two demonstrative cases. Several international reports from large epilepsy centers found the following clinical advantages of SEEG: 1) three-dimensional analysis of structures, including bilateral and multilobar structures; 2) low rate of complications; 3) less pneumoencephalopathy and less patient burden during postoperative course, which allows the initiation of video-EEG monitoring immediately after implantation and does not require resection to be performed in the same hospitalization; and 4) a higher rate of good seizure control after resection. In other words, SEEG more accurately identified the EZ than the SDE method. We obtained similar results in our preliminary experiences under limited conditions. In Japan, as of August 2022, dedicated electrodes and SEEG accessories have not been approved and the use of the robot arm is not widespread. The Japanese medical community is hopeful that these issues will soon be resolved and that the experience with SEEG in Japan will align with that of large epilepsy centers internationally.

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“…This therapy is indicated for patients with resection-unsuitable epilepsy, or as an additional treatment option. [ 3 , 11 , 18 ] VNS can cause stimulation-related adverse effects, including cough, hoarseness, dyspnea, and dysphagia, which are generally well-tolerated. [ 6 , 15 ] The misplacement of electrodes results in the ineffectiveness of therapy, as well as stimulation-induced neck muscle contraction.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative nerve stimulation during vagal nerve stimulator placement

Kamada,

Enatsu,

Kanno

et al. 2023

Surgical Neurology International

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Background: Vagal nerve stimulation (VNS) is a palliative treatment for refractory epilepsy and intraoperative nerve stimulation is applied to the vagal and other nerves to prevent electrode misplacement. We evaluated these thresholds to establish intraoperative monitoring procedures for VNS surgery. Methods: Forty-six patients who underwent intraoperative nerve stimulation during VNS placement were enrolled. The vagal nerve and other exposed nerves were electrically stimulated during surgery, and muscle contraction was confirmed by electromyography of the vocal cords and visual recognition of cervical muscle contraction. The nerve thresholds and the most sensitive parts of the vagal nerve were analyzed retrospectively. Results: The stimulation of vagal nerves induced vocal cord responses in all 46 patients; the median thresholds of the most sensitive parts and all parts were 0.2 mA (range: 0.05–0.75 mA) and 0.25 mA (range: 0.15–1.5 mA), respectively. The medial middle region was identified as the most sensitive part of the vagal nerve in the majority of participants (82.5%). In 11 patients, other cervical nerves were stimulated and sternohyoid muscle contraction was induced with a median threshold of 0.35 mA (range: 0.1–0.7 mA) in eight patients, while sternocleidomastoid muscle contraction was induced with a median threshold of 0.2 mA (range: 0.1–0.2 mA) in three. Conclusion: Intraoperative stimulation of vagal nerves induces vocal cord responses with locational variations, and the middle part stimulation could minimize the stimulus intensities. The nerves innervating the sternohyoid and sternocleidomastoid muscles may be exposed during the procedure. Knowledge of these characteristics will enhance the effectiveness of this technique in future applications.

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Current Status and Future Objectives of Surgical Therapies for Epilepsy in Japan

Cited by 5 publications

References 19 publications

Status of epilepsy care delivery and referral in clinics, hospitals, and epilepsy centers in Japan: A nationwide survey

Status of epilepsy care delivery and referral in clinics, hospitals, and epilepsy centers in Japan: A nationwide survey

Clinical Impacts of Stereotactic Electroencephalography on Epilepsy Surgery and Associated Issues in the Current Situation in Japan

Intraoperative nerve stimulation during vagal nerve stimulator placement

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