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- Jehi, L., et al.
(författare)
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Timing of referral to evaluate for epilepsy surgery: Expert Consensus Recommendations from the Surgical Therapies Commission of the International League Against Epilepsy
- 2022
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Ingår i: Epilepsia. - : Wiley. - 0013-9580 .- 1528-1167. ; 63:10, s. 2491-2506
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Tidskriftsartikel (refereegranskat)abstract
- Epilepsy surgery is the treatment of choice for patients with drug-resistant seizures. A timely evaluation for surgical candidacy can be life-saving for patients who are identified as appropriate surgical candidates, and may also enhance the care of nonsurgical candidates through improvement in diagnosis, optimization of therapy, and treatment of comorbidities. Yet, referral for surgical evaluations is often delayed while palliative options are pursued, with significant adverse consequences due to increased morbidity and mortality associated with intractable epilepsy. The Surgical Therapies Commission of the International League Against Epilepsy (ILAE) sought to address these clinical gaps and clarify when to initiate a surgical evaluation. We conducted a Delphi consensus process with 61 epileptologists, epilepsy neurosurgeons, neurologists, neuropsychiatrists, and neuropsychologists with a median of 22 years in practice, from 28 countries in all six ILAE world regions. After three rounds of Delphi surveys, evaluating 51 unique scenarios, we reached the following Expert Consensus Recommendations: (1) Referral for a surgical evaluation should be offered to every patient with drug-resistant epilepsy (up to 70 years of age), as soon as drug resistance is ascertained, regardless of epilepsy duration, sex, socioeconomic status, seizure type, epilepsy type (including epileptic encephalopathies), localization, and comorbidities (including severe psychiatric comorbidity like psychogenic nonepileptic seizures [PNES] or substance abuse) if patients are cooperative with management; (2) A surgical referral should be considered for older patients with drug-resistant epilepsy who have no surgical contraindication, and for patients (adults and children) who are seizure-free on 1-2 antiseizure medications (ASMs) but have a brain lesion in noneloquent cortex; and (3) referral for surgery should not be offered to patients with active substance abuse who are noncooperative with management. We present the Delphi consensus results leading up to these Expert Consensus Recommendations and discuss the data supporting our conclusions. High level evidence will be required to permit creation of clinical practice guidelines.
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| 2. |
- Malmgren, Kristina, 1952, et al.
(författare)
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Long-term outcomes of epilepsy surgery: Knowledge gaps and future directions
- 2015
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Ingår i: Long-Term Outcomes of Epilepsy Surgery in Adults and Children. - Cham : Springer. - 9783319177830 ; , s. 269-275
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Bokkapitel (refereegranskat)abstract
- Although epilepsy surgery has long been recognized as an effective treatment for carefully selected adults and children, studies of long-term seizure control are relatively rare and studies of the wider aspects of surgical outcome are even more scarce. In summarizing the literature, many of the chapters in this volume have highlighted what we do not know about epilepsy surgery outcomes rather than what we do. This chapter highlights the gaps in the adult and pediatric literature and discusses the roles that networking, collaboration, and adherence to a basic set of standards may play in addressing the current shortcomings of the literature. © Springer International Publishing Switzerland 2015.
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| 3. |
- Malmgren, Kristina, 1952, et al.
(författare)
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Why a volume on long-term outcomes of epilepsy surgery?
- 2015
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Ingår i: Long-Term Outcomes of Epilepsy Surgery in Adults and Children. - Cham : Springer. - 9783319177830 ; , s. 1-4
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Bokkapitel (refereegranskat)abstract
- Epilepsy surgery is a recognized option in the management of adults and children with drug-resistant epilepsy. Magnetic resonance imaging has increased the number of candidates by determining focal structural brain abnormalities not previously apparent. Advances in other techniques have widened the spectrum of surgical candidates both in adults and children. In the short term, rates of seizure freedom are relatively high, but seizure recurrence can still occur in the long term. There are methodological hurdles to overcome when assessing longer-term outcome. There are also the outcomes beyond seizures-cognition, neurodevelopment, academic and vocational outcomes, and quality of life-which are of importance when determining whether a treatment is benefi cial. The aim of this volume is to focus on longer-term outcomes from epilepsy surgery in both adults and children. © Springer International Publishing Switzerland 2015.
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