Surgery for Patients With Epilepsy Is Underused

Trends in the Rate of Surgery

“Although there are high-quality clinical trials and major epilepsy surgical centers throughout the United States, the number of operative procedures for drug-resistant focal epilepsy has remained stable over the past 20 years,” Dr. Cascino said. “The patient population and surgical techniques have changed. The number of anterior temporal lobectomies may be decreasing, but more patients are being considered for surgery with MRI-negative extratemporal seizures or multifocal seizures.”

In one study, researchers examined epilepsy surgeries performed between 1991 and 2011 on 1,346 patients in nine major surgery centers in the US, Germany, and Australia. In eight centers, the highest number of surgeries for mesial temporal sclerosis occurred in 1991 or 2001, the researchers found. In 2011, the nine centers performed 48% fewer such surgeries, compared with 1991 or 2001, with a parallel increase in the performance of surgery for nonlesional epilepsy. In addition, the number of intracranial EEG implantations that did not lead to subsequent brain resections rose by 0.6% per year.

The study authors called for future research to improve the use of epilepsy surgery, to assess the effectiveness of various surgical procedures and presurgical evaluation tools, and to study extratemporal epilepsy, given its growing contribution to the surgical epilepsy burden.

—Adriene Marshall

Suggested Reading

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Engel J Jr, McDermott MP, Wiebe S, et al. Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA. 2012;307(9):922-930.

Jehi L, Friedman D, Carlson C, et al. The evolution of epilepsy surgery between 1991 and 2011 in nine major epilepsy centers across the United States, Germany, and Australia. Epilepsia. 2015;56(10):1526-1533.

Jobst BC, Cascino GD. Resective epilepsy surgery for drug-resistant focal epilepsy: a review. JAMA. 2015;313(3):285-293.

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Wiebe S, Blume WT, Girvin JP, et al. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345(5):311-318.

Zhang J, Liu W, Chen H, et al. Identification of common predictors of surgical outcomes for epilepsy surgery. Neuropsychiatr Dis Treat. 2013;9:1673-1682.