Brain Surgery for Epilepsy Dramatically Underutilized

Despite the unequivocal effectiveness of brain surgery for treating uncontrolled epilepsy, the procedure has not been widely adopted, according to a new study.

Researchers from the University of California, San Francisco (UCSF; USA) performed a population-based cohort study with time trends (1990 to 2008) involving patients admitted to US hospitals for medically refractory focal epilepsy (MRFE). In all, 112,026 hospitalizations for MRFE and 6,653 resective surgeries (which included lobectomies and partial lobectomies) occurred during this period. The study timeline was centered on a decade-old landmark Canadian study that showed that nearly two-thirds of all people who underwent surgery in the 1990s were seizure-free.

The results showed that a trend of increasing hospitalizations over time was not accompanied by an increase in surgeries, producing an overall trend of decreasing surgery rates. Only a few hundred patients are treated surgically each year across the United States, with UCSF performing about 50 of these operations. Factors associated with this trend included a decrease in epilepsy hospitalizations at the highest-volume epilepsy centers, and increased hospitalizations to lower-volume hospitals that were found to be less likely to perform surgery. White patients were more likely to have surgery than racial minorities, and privately insured individuals were more likely to receive lobectomy than those with Medicaid or Medicare. The study was published in the April 17, 2012, issue of Neurology.

“Part of the problem is awareness, both among patients and care providers. New anticonvulsant drugs appear on the market often enough to provide physicians with new drug combinations for their patients to try,” said lead author Edward Chang, MD, chief of adult epilepsy surgery in the UCSF department of neurological surgery and the UCSF Epilepsy Center (San Francisco, CA, USA). “The problem though is that new medications are not very effective if previous ones already failed. Brain surgery can be more daunting than having to swallow fistfuls of pills, even though surgery is much more effective for many people.”

Epilepsy is a common and diverse set of chronic neurological disorders characterized by seizures that result from abnormal, excessive, or hyper-synchronous neuronal activity in the brain. Some definitions of epilepsy require that seizures be recurrent and unprovoked, but others require only a single seizure combined with brain alterations, which increase the chance of future seizures. Epilepsy affects about 50 million people worldwide, with nearly 90% of it occurring in developing countries.

Related Links:
University of California, San Francisco
UCSF Epilepsy Center