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Jehi L, Friedman D, Carlson C, Cascino G, Dewar S, Elger C, Engel J, Knowlton R, Kuzniecky R, McIntosh A, O'Brien TJ, Spencer D, Sperling MR, Worrell G, Bingaman B, Gonzalez-Martinez J, Doyle W, French J. The evolution of epilepsy surgery between 1991 and 2011 in nine major epilepsy centers across the United States, Germany, and Australia. Epilepsia 2015; 56:1526-33. [PMID: 26250432 DOI: 10.1111/epi.13116] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Epilepsy surgery is the most effective treatment for select patients with drug-resistant epilepsy. In this article, we aim to provide an accurate understanding of the current epidemiologic characteristics of this intervention, as this knowledge is critical for guiding educational, academic, and resource priorities. METHODS We profile the practice of epilepsy surgery between 1991 and 2011 in nine major epilepsy surgery centers in the United States, Germany, and Australia. Clinical, imaging, surgical, and histopathologic data were derived from the surgical databases at various centers. RESULTS Although five of the centers performed their highest number of surgeries for mesial temporal sclerosis (MTS) in 1991, and three had their highest number of MTS surgeries in 2001, only one center achieved its peak number of MTS surgeries in 2011. The most productive year for MTS surgeries varied then by center; overall, the nine centers surveyed performed 48% (95% confidence interval [CI] -27.3% to -67.4%) fewer such surgeries in 2011 compared to either 1991 or 2001, whichever was higher. There was a parallel increase in the performance of surgery for nonlesional epilepsy. Further analysis of 5/9 centers showed a yearly increase of 0.6 ± 0.07% in the performance of invasive electroencephalography (EEG) without subsequent resections. Overall, although MTS was the main surgical substrate in 1991 and 2001 (proportion of total surgeries in study centers ranging from 33.3% to 70.2%); it occupied only 33.6% of all resections in 2011 in the context of an overall stable total surgical volume. SIGNIFICANCE These findings highlight the major aspects of the evolution of epilepsy surgery across the past two decades in a sample of well-established epilepsy surgery centers, and the critical current challenges of this treatment option in addressing complex epilepsy cases requiring detailed evaluations. Possible causes and implications of these findings are discussed.
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Affiliation(s)
- Lara Jehi
- Department of Neurology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Daniel Friedman
- Department of Neurology, New York University, New York, New York, U.S.A
| | - Chad Carlson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Gregory Cascino
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Sandra Dewar
- Department of Neurology, University of California-Los Angeles, Los Angeles, California, U.S.A
| | | | - Jerome Engel
- Department of Neurology, University of California-Los Angeles, Los Angeles, California, U.S.A
| | - Robert Knowlton
- Department of Neurology, University of California-San Francisco, San Francisco, California, U.S.A
| | - Ruben Kuzniecky
- Department of Neurology, New York University, New York, New York, U.S.A
| | - Anne McIntosh
- The Department of Medicine, The Royal Melbourne and Austin Hospitals, University of Melbourne, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- The Department of Medicine, The Royal Melbourne and Austin Hospitals, University of Melbourne, Melbourne, Victoria, Australia
| | - Dennis Spencer
- Department of Neurology, Yale University, New Haven, Connecticut, U.S.A
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Bill Bingaman
- Department of Neurology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | | | - Werner Doyle
- Department of Neurology, New York University, New York, New York, U.S.A
| | - Jacqueline French
- Department of Neurology, New York University, New York, New York, U.S.A
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