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Trends in epilepsy surgery: stable surgical numbers despite increasing presurgical volumes.
- Source :
-
Journal of neurology, neurosurgery, and psychiatry [J Neurol Neurosurg Psychiatry] 2016 Dec; Vol. 87 (12), pp. 1322-1329. Date of Electronic Publication: 2016 Oct 05. - Publication Year :
- 2016
-
Abstract
- 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.<br />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.<br />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: 4.5% in 1990-1993 up to 21.1% in 2010-2013, total 13.4%) or declined from surgery (maximum 21.0% in 2010-2013, total 10.9%). One potential reason may be that increasingly detailed information on chances and risks were given over time.<br />Conclusions: The increasing volume of the presurgical programme largely compensates for decreasing numbers of surgically remediable syndromes and a growing rate of informed choice against epilepsy surgery. Although comprehensive diagnostic evaluation is offered to a larger group of epilepsy patients, surgical numbers remain stable.<br /> (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/.)
- Subjects :
- Adolescent
Adult
Aged
Brain Neoplasms epidemiology
Brain Neoplasms surgery
Child
Child, Preschool
Cohort Studies
Cross-Sectional Studies
Epilepsy, Temporal Lobe epidemiology
Epilepsy, Temporal Lobe surgery
Female
Follow-Up Studies
Germany
Humans
Infant
Infant, Newborn
Male
Malformations of Cortical Development, Group I epidemiology
Malformations of Cortical Development, Group I surgery
Middle Aged
Outcome Assessment, Health Care
Treatment Outcome
Treatment Refusal trends
Utilization Review trends
Young Adult
Epilepsy epidemiology
Epilepsy surgery
Neurosurgical Procedures statistics & numerical data
Neurosurgical Procedures trends
Subjects
Details
- Language :
- English
- ISSN :
- 1468-330X
- Volume :
- 87
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of neurology, neurosurgery, and psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 27707870
- Full Text :
- https://doi.org/10.1136/jnnp-2016-313831