BACKGROUND: Class I evidence for surgical effectiveness in refractory temporal lobe epilepsy (TLE) in 2001 led to an American Academy of Neurology practice parameter in 2003 recommending "referral to a surgical epilepsy center on failing appropriate trials of first-line antiepileptic drugs." We examined whether this led to a change in referral patterns to our epilepsy center. METHODS: We compared referral data for patients with TLE at our center for 1995 to 1998 (group 1, n = 83) and 2005 to 2008 (group 2, n = 102) to determine whether these recommendations resulted in a change in referral patterns for surgical evaluation. Patients with brain tumors, previous epilepsy surgery evaluations, or brain surgery (including epilepsy surgery) were excluded. RESULTS: We did not find a difference between the groups in the duration from the diagnosis of habitual seizures to referral (17.1 +/- 10.0 vs 18.6 +/- 12.6 years, p = 0.39) or the age at the time of evaluation (34.1 +/- 10.3 vs 37.0 +/- 11.8 years, p = 0.08). However, there was a difference in the distributions of age at evaluation (p = 0.03) and the duration of pharmacotherapy (p = 0.03) between the groups, with a greater proportion of patients in group 2 with drug-resistant epilepsy both earlier and later in their treatment course. Nonepileptic seizures were referred significantly earlier than TLE in either group or when combined. CONCLUSIONS: Our analysis does not identify a significantly earlier referral for epilepsy surgery evaluation as recommended in the practice parameter, but suggests a hopeful trend in this direction.
BACKGROUND: Class I evidence for surgical effectiveness in refractory temporal lobe epilepsy (TLE) in 2001 led to an American Academy of Neurology practice parameter in 2003 recommending "referral to a surgical epilepsy center on failing appropriate trials of first-line antiepileptic drugs." We examined whether this led to a change in referral patterns to our epilepsy center. METHODS: We compared referral data for patients with TLE at our center for 1995 to 1998 (group 1, n = 83) and 2005 to 2008 (group 2, n = 102) to determine whether these recommendations resulted in a change in referral patterns for surgical evaluation. Patients with brain tumors, previous epilepsy surgery evaluations, or brain surgery (including epilepsy surgery) were excluded. RESULTS: We did not find a difference between the groups in the duration from the diagnosis of habitual seizures to referral (17.1 +/- 10.0 vs 18.6 +/- 12.6 years, p = 0.39) or the age at the time of evaluation (34.1 +/- 10.3 vs 37.0 +/- 11.8 years, p = 0.08). However, there was a difference in the distributions of age at evaluation (p = 0.03) and the duration of pharmacotherapy (p = 0.03) between the groups, with a greater proportion of patients in group 2 with drug-resistant epilepsy both earlier and later in their treatment course. Nonepileptic seizures were referred significantly earlier than TLE in either group or when combined. CONCLUSIONS: Our analysis does not identify a significantly earlier referral for epilepsy surgery evaluation as recommended in the practice parameter, but suggests a hopeful trend in this direction.
Authors: Athanasios Grivas; Johannes Schramm; Thomas Kral; Marec von Lehe; Christoph Helmstaedter; Christian E Elger; Hans Clusmann Journal: Epilepsia Date: 2006-08 Impact factor: 5.864
Authors: J T Langfitt; R G Holloway; M P McDermott; S Messing; K Sarosky; A T Berg; S S Spencer; B G Vickrey; M R Sperling; C W Bazil; S Shinnar Journal: Neurology Date: 2007-04-17 Impact factor: 9.910
Authors: G D Cascino; M R Trenerry; E L So; F W Sharbrough; C Shin; T D Lagerlund; M L Zupanc; C R Jack Journal: Epilepsia Date: 1996-07 Impact factor: 5.864
Authors: F Arruda; F Cendes; F Andermann; F Dubeau; J G Villemure; M Jones-Gotman; N Poulin; D L Arnold; A Olivier Journal: Ann Neurol Date: 1996-09 Impact factor: 10.422
Authors: Christine B Baca; Huibrie C Pieters; Tomoko J Iwaki; Gary W Mathern; Barbara G Vickrey Journal: Epilepsia Date: 2015-04-20 Impact factor: 5.864
Authors: Christine B Baca; Barbara G Vickrey; Stefanie Vassar; Jason S Hauptman; Andrew Dadour; Taemin Oh; Noriko Salamon; Harry V Vinters; Raman Sankar; Gary W Mathern Journal: Neurology Date: 2013-03-06 Impact factor: 9.910