Epilepsy surgery, delays and referral patterns - are all your epilepsy patients controlled?
Epilepsy surgery, delays and referral patterns - are all your epilepsy patients controlled?
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DOI：
10.1016/s1059-1311(02)00320-5
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发表时间：
2003-04-01
影响因子：
3
通讯作者：
Vale, FL
中科院分区：
文献类型：
--
作者：
Benbadis, SR;Heriaud, L;Vale, FL
理由：癫痫手术是治疗难治性癫痫的标准治疗方法，但尚未得到充分利用。我们描述了癫痫手术的结果和转诊癫痫项目的转诊模式。方法：我们回顾了 2000 年和 2001 年在南佛罗里达大学和坦帕总医院癫痫项目进行的癫痫手术的结果。典型的术前评估包括临床评估、EEG 视频监测、专用癫痫方案的 MRI、PET、SPECT、神经心理学测试和 Wada 测试。我们使用恩格尔结果分类，并重点关注转诊信息，以确定患者在病程中如何以及何时到达转诊癫痫中心。结果：在 2 年期间（2000-2001 年），总共进行了 36 例癫痫手术。 29 例颞叶切除术、6 例颞叶外切除术和 1 例胼胝体切开术。年龄从17岁到65岁不等。总体结果为：30 例（83%）无癫痫发作[I 级]，5 例（17%）罕见癫痫发作或几乎无癫痫发作[II 级]，I 例无改善。在 29 例颞叶切除术中，27 例 (93%) 完全无癫痫发作 [I 级]，2 例 (7%) 病情改善 >90% [II 级]。到癫痫中心就诊之前的癫痫发作持续时间平均为 18 年（范围 2-58 年）。 22 名 (61%) 是由神经科医生派来的，而 14 名 (39%) 是自我推荐而来，没有与神经科医生讨论手术事宜。五人 (14%) 的神经科医生特别建议不要考虑手术。其中两人在到癫痫中心就诊之前曾参加过抗癫痫药物（AED）的临床试验。结论：癫痫手术疗效高且发病率极低。然而，将患者转诊至癫痫中心的时间仍然很长，这表明癫痫手术并未得到充分利用。 (C) 2003 BEA Trading Ltd. 由 Elsevier Science Ltd 出版。保留所有权利。
Rationale: Epilepsy surgery is a standard of care in the treatment of medically intractable epilepsy, but is underutilised. We describe the results of epilepsy surgery and the referral patterns at a referral epilepsy programme.Methods: We reviewed the outcome of epilepsy surgery performed at the University of South Florida and Tampa General Hospital epilepsy programme for the years 2000 and 2001. The typical presurgical evaluation included clinical evaluation, EEG-video monitoring, MRI with dedicated epilepsy protocol, PET, SPECT, neuropsychological testing and Wada testing. We used the Engel outcome classification, and focused on the referral information to determine how and when in the course of their illness patients arrive at a referral epilepsy centre.Results: In the 2-year period (2000-2001), a total of 36 epilepsy surgeries were performed. Twenty-nine temporal lobectomies, six extratemporal resections and one corpus callosotomy. Ages varied from 17 to 65 years. Overall results were: 30 (83%) seizure-free [class I], 5 (17%) rare seizures or almost seizure-free [class II] and I no improvement. Of the 29 temporal lobectomies, 27 (93%) are completely seizure-free [class I] and 2 (7%) are >90% improved [class II]. Duration of seizures before being seen at the epilepsy centre averaged 18 years (range 2-58 years). Twenty-two (61%) were sent by their neurologists, while 14 (39%) came self-referred without having discussed surgery with their neurologists. Five (14%) were specifically advised by their neurologist to not consider surgery. Two had participated in clinical trials of antiepileptic drugs (AEDs) before being seen at the epilepsy centre.Conclusions: Epilepsy surgery has high efficacy and very low morbidity. Yet, there continues to be a long delay in the referral of patients to the epilepsy centre, suggesting that surgery for epilepsy is underutilised. (C) 2003 BEA Trading Ltd. Published by Elsevier Science Ltd. All rights reserved.