Document Detail

Referral pattern for epilepsy surgery after evidence-based recommendations: a retrospective study.
MedLine Citation:
PMID:  20733145     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Class I evidence for surgical effectiveness in refractory temporal lobe epilepsy (TLE) in 2001 led to an American Academy of Neurology practice parameter in 2003 recommending "referral to a surgical epilepsy center on failing appropriate trials of first-line antiepileptic drugs." We examined whether this led to a change in referral patterns to our epilepsy center.
METHODS: We compared referral data for patients with TLE at our center for 1995 to 1998 (group 1, n = 83) and 2005 to 2008 (group 2, n = 102) to determine whether these recommendations resulted in a change in referral patterns for surgical evaluation. Patients with brain tumors, previous epilepsy surgery evaluations, or brain surgery (including epilepsy surgery) were excluded.
RESULTS: We did not find a difference between the groups in the duration from the diagnosis of habitual seizures to referral (17.1 +/- 10.0 vs 18.6 +/- 12.6 years, p = 0.39) or the age at the time of evaluation (34.1 +/- 10.3 vs 37.0 +/- 11.8 years, p = 0.08). However, there was a difference in the distributions of age at evaluation (p = 0.03) and the duration of pharmacotherapy (p = 0.03) between the groups, with a greater proportion of patients in group 2 with drug-resistant epilepsy both earlier and later in their treatment course. Nonepileptic seizures were referred significantly earlier than TLE in either group or when combined.
CONCLUSIONS: Our analysis does not identify a significantly earlier referral for epilepsy surgery evaluation as recommended in the practice parameter, but suggests a hopeful trend in this direction.
Zulfi Haneef; John Stern; Sandra Dewar; Jerome Engel
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurology     Volume:  75     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-24     Completed Date:  2010-10-18     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  699-704     Citation Subset:  AIM; IM    
Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Los Angeles, CA 90095-1769, USA.
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MeSH Terms
Age Distribution
Epilepsy / drug therapy,  surgery
Epilepsy, Temporal Lobe / drug therapy,  surgery*
Evidence-Based Medicine*
Health Planning Guidelines*
Middle Aged
Neurosurgical Procedures / standards*,  trends*
Practice Guidelines as Topic / standards*
Referral and Consultation / trends*
Retrospective Studies
Grant Support
Comment In:
Neurology. 2010 Aug 24;75(8):678-9   [PMID:  20733142 ]
Erratum In:
Neurology. 2010 Nov 23;75(21):1945
Summary for patients in:
Neurology. 2010 Aug 24;75(8):e41-2   [PMID:  20733140 ]

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