Timing of referral to evaluate for epilepsy surgery: Expert Consensus Recommendations from the Surgical Therapies Commission of the International League Against Epilepsy.
drug-resistant epilepsy
epilepsy surgery
health care delivery
neuromodulation
public health
treatment
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
10 2022
10 2022
Historique:
revised:
25
06
2022
received:
01
03
2022
accepted:
27
06
2022
pubmed:
18
7
2022
medline:
14
10
2022
entrez:
17
7
2022
Statut:
ppublish
Résumé
Epilepsy surgery is the treatment of choice for patients with drug-resistant seizures. A timely evaluation for surgical candidacy can be life-saving for patients who are identified as appropriate surgical candidates, and may also enhance the care of nonsurgical candidates through improvement in diagnosis, optimization of therapy, and treatment of comorbidities. Yet, referral for surgical evaluations is often delayed while palliative options are pursued, with significant adverse consequences due to increased morbidity and mortality associated with intractable epilepsy. The Surgical Therapies Commission of the International League Against Epilepsy (ILAE) sought to address these clinical gaps and clarify when to initiate a surgical evaluation. We conducted a Delphi consensus process with 61 epileptologists, epilepsy neurosurgeons, neurologists, neuropsychiatrists, and neuropsychologists with a median of 22 years in practice, from 28 countries in all six ILAE world regions. After three rounds of Delphi surveys, evaluating 51 unique scenarios, we reached the following Expert Consensus Recommendations: (1) Referral for a surgical evaluation should be offered to every patient with drug-resistant epilepsy (up to 70 years of age), as soon as drug resistance is ascertained, regardless of epilepsy duration, sex, socioeconomic status, seizure type, epilepsy type (including epileptic encephalopathies), localization, and comorbidities (including severe psychiatric comorbidity like psychogenic nonepileptic seizures [PNES] or substance abuse) if patients are cooperative with management; (2) A surgical referral should be considered for older patients with drug-resistant epilepsy who have no surgical contraindication, and for patients (adults and children) who are seizure-free on 1-2 antiseizure medications (ASMs) but have a brain lesion in noneloquent cortex; and (3) referral for surgery should not be offered to patients with active substance abuse who are noncooperative with management. We present the Delphi consensus results leading up to these Expert Consensus Recommendations and discuss the data supporting our conclusions. High level evidence will be required to permit creation of clinical practice guidelines.
Identifiants
pubmed: 35842919
doi: 10.1111/epi.17350
pmc: PMC9562030
mid: NIHMS1820930
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2491-2506Subventions
Organisme : NINDS NIH HHS
ID : R21 NS122389
Pays : United States
Organisme : NINDS NIH HHS
ID : U54 NS100064
Pays : United States
Organisme : NHLBI NIH HHS
ID : OT2 HL161847
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL061847
Pays : United States
Organisme : NINDS NIH HHS
ID : U24 NS107201
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS097719
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA202911
Pays : United States
Informations de copyright
© 2022 International League Against Epilepsy.
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