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Technology for the generalist. Evidence for the specialist. Individual outcomes for the patient
In their JNNP paper, Gooneratna et al1 review long-term studies of three surgical therapies for pharmacoresistant focal epilepsy: vagal nerve stimulation, which provides the most evidence, anterior thalamic nucleus deep brain stimulation (ANT DBS) and cortical responsive stimulation (CRS). Written for the generalist, the review describes the three technologies in detail. The multiple layers of information gathered inform the generalist of how complex treatment decisions can be. As medical intractability can be predicted early, typically after failure of a second drug or the presence of abnormal imaging, this serves as a reminder that such patients should be considered for early referral to a specialist multidisciplinary …
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