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

Abstract

This study investigated the number of epilepsy surgeries performed over time in Japan, and conducted a questionnaire survey of the Japan Neurosurgical Society (JNS) training program core hospitals to determine the current status and future objectives of surgical therapies and epilepsy training programs for physicians in Japan. This article presents part of a presentation delivered as a presidential address at the 44th Annual Meeting of the Epilepsy Surgery Society of Japan held in January 2021. The number of epilepsy surgeries performed per year has increased in Japan since 2011 to around 1,200 annually between 2015 and 2018. The questionnaire survey showed that 50% of the responding hospitals performed epilepsy surgery and 29% had an epilepsy center, and that these hospitals provided senior residents with education regarding epilepsy surgery. The presence of an epilepsy center in a hospital was positively correlated with the availability of long-term video electroencephalography monitoring beds as well as the number of epilepsy surgeries performed at the hospital. In regions with no medical facilities offering specialized surgical therapies for epilepsy, the JNS training program core hospitals may help improve epilepsy diagnosis and treatment. They may also increase the number of safe and effective surgeries by establishing epilepsy centers that can perform long-term video electroencephalography monitoring, providing junior neurosurgeons with training regarding epilepsy, and playing a core role in surgical therapies for epilepsy in tertiary medical areas in close cooperation with neighboring medical facilities.

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

“…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.…”

“…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.…”

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

“…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.…”

Intraoperative nerve stimulation during vagal nerve stimulator placement

“…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.…”