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Predictors for being offered epilepsy surgery: 5-year experience of a tertiary referral centre
  1. Chiara Fois1,2,3,
  2. Stjepana Kovac1,3,4,
  3. Aytakin Khalil1,
  4. Gülnur Tekgöl Uzuner3,5,
  5. Beate Diehl1,3,
  6. Tim Wehner1,3,
  7. John S Duncan1,3,
  8. Matthew C Walker1,3
  1. 1UCL Institute of Neurology, UCL, London, UK
  2. 2Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
  3. 3Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK
  4. 4Department of Neurology, University of Muenster, Muenster, Germany
  5. 5Department of Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
  1. Correspondence to Dr Chiara Fois, Unit of Neurology, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro, 10, Sassari 07100, Italy; chiarafois{at}hotmail.it

Abstract

Objectives To define factors that predict whether patients with pharmacoresistant focal epilepsy are offered epilepsy surgery (including invasive EEG) and the main reasons for not proceeding with these after non-invasive presurgical evaluation.

Methods We retrospectively analysed data from 612 consecutive patients with focal epilepsy admitted to a video-EEG Telemetry Unit for presurgical evaluation, and used a multivariate logistic regression model to assess the predictive value of factors for being offered potentially curative surgery.

Results In the multivariate analysis, bilateral lesions on MRI (OR: 0.10; 95% CI 0.03 to 0.24), no lesion (OR: 0.33; 95% CI 0.22 to 0.49) or extratemporal lobe epilepsy (OR: 0.30; 95% CI 0.20 to 0.45) were the only factors that significantly reduced the probability of being offered surgery. 32% of patients who were offered epilepsy surgery decided against proceeding.

Conclusions There was a low chance (<10%) of being offered surgery if there were bilateral lesions on MRI and extratemporal lobe epilepsy. Patients should be given advice on the risk/benefit ratio and of realistic outcomes of epilepsy surgery; this may help reduce the number of patients who refuse surgery after comprehensive workup.

  • EPILEPSY, SURGERY
  • TELEMETRY
  • NEUROSURGERY

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