Guidelines Fail to Expedite Surgical Treatment of Epilepsy

Evidence-based guidelines have had no impact on increasing timely referrals for surgery in patients with drug-refractory seizures, according to a new study.

Researchers at the University of California, Los Angeles (UCLA; USA) reviewed data on 85 patients with refractory temporal lobe epilepsy (TLE) who were seen in the UCLA epilepsy-monitoring unit after surgical referral, between 1997 and 1998, and 132 further patients who were seen from 2004 to 2008. The researchers found that both the earlier and later groups were no different in age at diagnosis (16.7 versus 18.6 years), duration of epilepsy (17.2 versus 17.5 years), or age at referral (33.9 versus 36.1 years. The researchers further reported that compared to a group of patients with nonepileptic seizures, those with TLE were actually referred to the epilepsy-monitoring unit significantly later. The study was presented at the annual meeting of the American Epilepsy Society (West Hartford, CT, USA), held during December 2009 in Boston (MD, USA).

"We believed that failure to refer patients with pharma coresistant epilepsy for surgery has remained a major problem despite...official recommendations,” said Jerome Engel, Jr., M.D. "Patients with epileptic seizures that persist after treatment with two antiepileptic drugs should be referred to an epilepsy center for a surgical evaluation. If they are surgical candidates there is an excellent chance that they will become free of disabling seizures postoperatively."

Temporal lobe epilepsies are a group of medical disorders in which humans and animals experience recurrent epileptic seizures arising from one or both temporal lobes of the brain. Mesial temporal lobe epilepsy (MTLE) arises in the hippocampus, amygdala, and parahippocampal gyrus, which are located in the inner aspect of the temporal lobe.

Lateral temporal lobe epilepsy (LTLE) arises in the neocortex on the outer surface of the temporal lobe of the brain. Because of strong interconnections, seizures beginning in either the medial or lateral temporal areas often spread to involve both areas and also to neighboring areas on the same side of the brain, as well as the temporal lobe on the opposite side of the brain. Since 2003, the American association of neurology has recommended that patients who fail appropriate trials of first-line antiepileptic agents be referred for surgery.

Related Links:
University of California, Los Angeles
American Epilepsy Society