A survey of neurologists’ views on epilepsy surgery and medically refractory epilepsy

Hakimi, Andrea S.; Spanaki, Marianna V.; Schuh, Lori A.; Smith, Brien; Schultz, Lonni

doi:10.1016/j.yebeh.2008.02.003

Cited by 105 publications

(104 citation statements)

References 15 publications

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“…11 Epilepsy surgery remains underutilized, 12 and patients average nearly 20 years before being referred for a surgical evaluation. 13 Neurologists are often reluctant to consider epilepsy surgery in the early stages of disease, 14 have difficulties defining drug-resistant epilepsy, 14 may not be informed about the risks and benefits of epilepsy surgery, and may be poorly equipped to identify patients who are potential surgical candidates. 15 To date, no studies have been published examining the knowledge and perceptions of epilepsy surgery in Canadian neurologists, and studies conducted in Europe and the United States have either not been comprehensive or had low response rates.…”

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confidence: 99%

“…15 To date, no studies have been published examining the knowledge and perceptions of epilepsy surgery in Canadian neurologists, and studies conducted in Europe and the United States have either not been comprehensive or had low response rates. 14,16,17 In the current study, we aimed to assess potential neurologist-related barriers to epilepsy surgery among Canadian neurologists nationwide.…”

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confidence: 99%

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Neurologists' knowledge of and attitudes toward epilepsy surgery

Roberts

Hrazdil

Wiebe³

et al. 2015

Neurology

104

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Objectives: In the current study, we aim to assess potential neurologist-related barriers to epilepsy surgery among Canadian neurologists.Methods: A 29-item, pilot-tested questionnaire was mailed to all neurologists registered to practice in Canada. Survey items included the following: (1) type of medical practice, (2) perceptions of surgical risks and benefits, (3) knowledge of existing practice guidelines, and (4) barriers to surgery for patients with epilepsy. Neurologists who did not complete the questionnaire after the initial mailing were contacted a second time by e-mail, fax, or telephone. After this reminder, the survey was mailed a second time to any remaining nonresponders.Results: In total, 425 of 796 neurologists returned the questionnaire (response rate 53.5%). Respondents included 327 neurologists who followed patients with epilepsy in their practice. More than half (56.6%) of neurologists required patients to be drug-resistant and to have at least one seizure per year before considering surgery, and nearly half (48.6%) failed to correctly define drug-resistant epilepsy. More than 75% of neurologists identified inadequate health care resources as the greatest barrier to surgery for patients with epilepsy.Conclusions: A substantial proportion of Canadian neurologists are unaware of recommended standards of practice for epilepsy surgery. Access also appears to be a significant barrier to epilepsy surgery and surgical evaluation. As a result, we are concerned that patients with epilepsy are receiving inadequate care. A greater emphasis must be placed on knowledge dissemination and ensuring that the infrastructure and personnel are in place to allow patients to have timely access to this evidence-based treatment. Neurology ® 2015;84:159-166

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confidence: 99%

mentioning

confidence: 99%

Neurologists' knowledge of and attitudes toward epilepsy surgery

Roberts

Hrazdil

Wiebe³

et al. 2015

Neurology

104

View full text Add to dashboard Cite

show abstract

“…The understanding that MTS occurs remotely from prior areas of infarction and is involved in the epileptic network contributing to medically intractable epilepsy is well recognized. 5,18,19 Hemispherotomy certainly circumvents the problem of widespread epileptogenic networks in the setting of early vascular injury and is one of the most effective forms of epilepsy surgery across all etiologies, with seizure freedom rates as high as more than 90%. 1,35,36 Hemispheric disconnection/anatomical resection has been the mainstay of surgical therapy for large perinatal porencephalic cysts after MCA stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Four other patients had epilepsy associated with hemorrhage resulting from vascular malformations, including 2 males and 2 females, ranging in age from 6 months to 16 years (Table 1, Cases [16][17][18][19]. Etiologies included a vein of Galen malformation in a patient who experienced a treatment-related subarachnoid and intraventricular hemorrhage in the neonatal period.…”

Section: Cases 16-19mentioning

confidence: 99%

“…13,16,25 Epilepsy surgery in children is safe and effective and can provide substantive gains in quality of life and developmental milestones, 15,36 but in general, it remains an underutilized treatment modality for multiple reasons, including but not limited to historical prejudice, practitioner bias, and parental concern over loss of functional capability. 9,12,19,29 While significant experience has been gained in the surgical treatment of childhood epilepsy secondary to malformations of cortical development and benign tumors, very little has been reported focused on stroke or other vasculogenic causes in children. 7,11,28 In this paper, to demonstrate the safety and efficacy of epilepsy surgery in this population, we describe our series of patients who experienced medically refractory epilepsy due to perinatal infarction and/or hemorrhage, and underwent surgery.…”

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Surgical management of medically refractory epilepsy due to early childhood stroke

Ghatan

McGoldrick

Palmese

et al. 2014

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Object The risk of developing epilepsy after perinatal stroke, hypoxic/ischemic injury, and intracerebral hemorrhage is significant, and seizures may become medically refractory in approximately 25% of these patients. Surgical management can be difficult due to multilobar or bilateral cortical injury, nonfocal or poorly lateralizing video electroencephalography (EEG) findings, and limited functional reserve. In this study the authors describe the surgical approaches, seizure outcomes, and complications in patients with epilepsy due to vascular etiologies in the perinatal period and early infancy. Methods The records were analyzed of 19 consecutive children and adults with medically refractory epilepsy and evidence of perinatal arterial branch occlusions, hypoxic/ischemic insult, or hemorrhagic strokes, who underwent surgery at the Comprehensive Epilepsy Center of Beth Israel Medical Center and St. Luke's-Roosevelt Hospital Center. Preoperative findings including MRI, video EEG, functional MRI, and neuropsychological testing were analyzed. The majority of patients underwent staged operations with invasive mapping, and all patients had either extra- or intraoperative functional mapping. Results In 7 patients with large porencephalic cysts due to major arterial branch occlusions, periinsular functional hemispherotomy was performed in 4 children, and in 3 patients, multilobar resections/disconnections were performed, with 1 patient undergoing additional resections 3 years after initial surgery due to recurrence of seizures. All of these patients have been seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 15–77 months). Another 8 patients had intervascular border-zone ischemic infarcts and encephalomalacia, and in this cohort 2 hemispherotomies, 5 multilobar resections/disconnections, and 1 focal cortical resection were performed. Seven of these patients remain seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 9–94 months), and 1 patient suffered a single seizure after 2.5 years of seizure freedom (Engel Class IB, 33-month follow-up). In the final 4 patients with vascular malformation-associated hemorrhagic or ischemic infarction in the perinatal period, a hemispherotomy was performed in 1 case, multilobar resections in 2 cases, and in 1 patient a partial temporal lobectomy was performed, followed 6 months later by a complete temporal and occipital lobectomy due to ongoing seizures. All of these patients have had seizure freedom (Engel Class IA) with a mean follow-up of 4.5 years (range 10–80 months). Complications included transient monoparesis or hemiparesis in 3 patients, transient mutism in 1 patient, infection in 1 patient, and a single case of permanent distal lower-extremity weakness. Transient mood disorders (depression and anxiety) were observed in 2 patients and required medical/therapeutic intervention. Conclusions Epilepsy surgery is effective in controlling medically intractable seizures after perinatal vascular insults. Seizure foci tend to be widespread and rarely limited to the area of injury identified through neuroimaging, with invasive monitoring directing multilobar resections in many cases. Long-term functional outcomes have been good in these patients, with significant improvements in independence, quality of life, cognitive development, and motor skills, despite transient postoperative monoparesis or hemiparesis and occasional mood disorders.