Chiara Fois1, Stjepana Kovac2, Aytakin Khalil3, Gülnur Tekgöl Uzuner4, Beate Diehl5, Tim Wehner5, John S Duncan5, Matthew C Walker5. 1. UCL Institute of Neurology, UCL, London, UK Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK. 2. UCL Institute of Neurology, UCL, London, UK Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK Department of Neurology, University of Muenster, Muenster, Germany. 3. UCL Institute of Neurology, UCL, London, UK. 4. Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK Department of Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey. 5. UCL Institute of Neurology, UCL, London, UK Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK.
Abstract
OBJECTIVES: To define factors that predict whether patients with pharmacoresistant focal epilepsy are offered epilepsy surgery (including invasive EEG) and the main reasons for not proceeding with these after non-invasive presurgical evaluation. METHODS: We retrospectively analysed data from 612 consecutive patients with focal epilepsy admitted to a video-EEG Telemetry Unit for presurgical evaluation, and used a multivariate logistic regression model to assess the predictive value of factors for being offered potentially curative surgery. RESULTS: In the multivariate analysis, bilateral lesions on MRI (OR: 0.10; 95% CI 0.03 to 0.24), no lesion (OR: 0.33; 95% CI 0.22 to 0.49) or extratemporal lobe epilepsy (OR: 0.30; 95% CI 0.20 to 0.45) were the only factors that significantly reduced the probability of being offered surgery. 32% of patients who were offered epilepsy surgery decided against proceeding. CONCLUSIONS: There was a low chance (<10%) of being offered surgery if there were bilateral lesions on MRI and extratemporal lobe epilepsy. Patients should be given advice on the risk/benefit ratio and of realistic outcomes of epilepsy surgery; this may help reduce the number of patients who refuse surgery after comprehensive workup. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVES: To define factors that predict whether patients with pharmacoresistant focal epilepsy are offered epilepsy surgery (including invasive EEG) and the main reasons for not proceeding with these after non-invasive presurgical evaluation. METHODS: We retrospectively analysed data from 612 consecutive patients with focal epilepsy admitted to a video-EEG Telemetry Unit for presurgical evaluation, and used a multivariate logistic regression model to assess the predictive value of factors for being offered potentially curative surgery. RESULTS: In the multivariate analysis, bilateral lesions on MRI (OR: 0.10; 95% CI 0.03 to 0.24), no lesion (OR: 0.33; 95% CI 0.22 to 0.49) or extratemporal lobe epilepsy (OR: 0.30; 95% CI 0.20 to 0.45) were the only factors that significantly reduced the probability of being offered surgery. 32% of patients who were offered epilepsy surgery decided against proceeding. CONCLUSIONS: There was a low chance (<10%) of being offered surgery if there were bilateral lesions on MRI and extratemporal lobe epilepsy. Patients should be given advice on the risk/benefit ratio and of realistic outcomes of epilepsy surgery; this may help reduce the number of patients who refuse surgery after comprehensive workup. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Benjamin D Wissel; Hansel M Greiner; Tracy A Glauser; Katherine D Holland-Bouley; Francesco T Mangano; Daniel Santel; Robert Faist; Nanhua Zhang; John P Pestian; Rhonda D Szczesniak; Judith W Dexheimer Journal: Epilepsia Date: 2019-11-29 Impact factor: 5.864
Authors: Petroula Laiou; Eleftherios Avramidis; Marinho A Lopes; Eugenio Abela; Michael Müller; Ozgur E Akman; Mark P Richardson; Christian Rummel; Kaspar Schindler; Marc Goodfellow Journal: Front Neurol Date: 2019-10-01 Impact factor: 4.003