Predictors for being offered epilepsy surgery: 5-year experience of a tertiary referral centre: Table 1

Fois, Chiara; Kovač, Stjepana; Khalil, Aytakin; Uzuner, Nevzat; Diehl, Beate; Wehner, Tim; Duncan, John S.; Walker, Matthew C.

doi:10.1136/jnnp-2014-310148

Cited by 21 publications

(37 citation statements)

References 8 publications

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“…Although Grade 1 patients predominantly underwent temporal lobectomies, it is noteworthy that of the 36 cases of unilateral MTS, 30 were classified as Grade 1, and 6 were classified as Grade 2, with a total of 19 going on to becoming seizure‐free. Patients with temporal lobe epilepsy and those with structural lesions are more likely than patients with extratemporal and nonlesional epilepsy to be considered optimal surgical candidates as supported by the literature, and reflected by the ESGS. However, it is important to acknowledge that extratemporal lesional cases have the potential to be excellent candidates for resective surgery, but may often require additional confirmation of localization.…”

Section: Discussionmentioning

confidence: 87%

Derivation and initial validation of a surgical grading scale for the preliminary evaluation of adult patients with drug‐resistant focal epilepsy

et al. 2017

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Section: Discussionmentioning

confidence: 87%

Derivation and initial validation of a surgical grading scale for the preliminary evaluation of adult patients with drug‐resistant focal epilepsy

et al. 2017

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“…Possible reasons are more extended information about chances and risks of surgery (as documented by the increasingly comprehensive information sheets before surgery (table 2)). Recently, the following reasons for patients to step back from surgery were reported: dissatisfaction with the predicted likelihood to become seizure free (52%), scepticism related to intracranial recordings (51%) and concerns about surgical risks (14%) 35. Another explanation might be fewer patients with a clear upfront motivation for surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Trends in epilepsy surgery: stable surgical numbers despite increasing presurgical volumes

Cloppenborg

May

Blümcke³

et al. 2016

J Neurol Neurosurg Psychiatry

122

116

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Introduction Despite the success of epilepsy surgery, recent reports suggest a decline in surgical numbers. We tested these trends in our cohort to elucidate potential reasons. Patients and methods Presurgical, surgical and postsurgical data of all patients undergoing presurgical evaluation in between 1990 and 2013 were retrospectively analysed. Patients were grouped according to the underlying pathology. Results A total of 3060 patients were presurgically studied, and resective surgery was performed in 66.8% (n=2044) of them: medial temporal sclerosis (MTS): n=675, 33.0%; benign tumour (BT): n=408, 20.0%; and focal cortical dysplasia (FCD): n=284, 13.9%. Of these, 1929 patients (94.4%) had a follow-up of 2 years, and 50.8% were completely seizure free (Engel IA). Seizure freedom rate slightly improved over time. Presurgical evaluations continuously increased, whereas surgical interventions did not. Numbers for MTS, BT and temporal lobe resections decreased since 2009. The number of non-lesional patients and the need for intracranial recordings increased. More evaluated patients did not undergo surgery (more than 50% in 2010-2013) because patients were not suitable (mainly due to missing hypothesis:

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“…For example, a study showed that some patients simply decline surgery due to costs or fear. 1 Indeed, a study performed at a tertiary epilepsy center in the United Kingdom showed that 32% of patients offered surgery declined to proceed, 6 which may indicate that some appropriate candidates are not undergoing surgery because of personal preferences and preconceived notions regarding surgery. Another reason might be poor communication and relationships between community neurologists and surgical epilepsy centers.…”

Section: Discussionmentioning

confidence: 99%

Strategic hospital partnerships: improved access to care and increased epilepsy surgical volume

Vadera¹,

Chan²,

Mnatsankanyan³

et al. 2018

Neurosurgical Focus

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OBJECTIVESurgical treatment of patients with medically refractory focal epilepsy is underutilized. Patients may lack access to surgically proficient centers. The University of California, Irvine (UCI) entered strategic partnerships with 2 epilepsy centers with limited surgical capabilities. A formal memorandum of understanding (MOU) was created to provide epilepsy surgery to patients from these centers.METHODSThe authors analyzed UCI surgical and financial data associated with patients undergoing epilepsy surgery between September 2012 and June 2016, before and after institution of the MOU. Variables collected included the length of stay, patient age, seizure semiology, use of invasive monitoring, and site of surgery as well as the monthly number of single-surgery cases, complex cases (i.e., staged surgeries), and overall number of surgery cases.RESULTSOver the 46 months of the study, a total of 104 patients underwent a total of 200 operations; 71 operations were performed in 39 patients during the pre-MOU period (28 months) and 129 operations were performed in 200 patients during the post-MOU period (18 months). There was a significant difference in the use of invasive monitoring, the site of surgery, the final therapy, and the type of insurance. The number of single-surgery cases, complex-surgery cases, and the overall number of cases increased significantly.CONCLUSIONSPartnerships with outside epilepsy centers are a means to increase access to surgical care. These partnerships are likely reproducible, can be mutually beneficial to all centers involved, and ultimately improve patient access to care.

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Predictors for being offered epilepsy surgery: 5-year experience of a tertiary referral centre: Table 1

Cited by 21 publications

References 8 publications

Derivation and initial validation of a surgical grading scale for the preliminary evaluation of adult patients with drug‐resistant focal epilepsy

Derivation and initial validation of a surgical grading scale for the preliminary evaluation of adult patients with drug‐resistant focal epilepsy

Trends in epilepsy surgery: stable surgical numbers despite increasing presurgical volumes

Strategic hospital partnerships: improved access to care and increased epilepsy surgical volume

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