A prospective study of the requirement for and the provision of epilepsy surgery in the United Kingdom.
OBJECTIVE
Of the 30,000 persons in whom epilepsy develops annually in the United Kingdom, in approximately 6000 (20%), intractability develops. Some of these patients will be appropriate for epilepsy surgery. We aimed to estimate the number of patients who should be considered surgical candidates, by extrapolation from a population-based study of prognosis and the number who are receiving epilepsy surgery, by a survey of U.K. neurosurgeons.


METHODS
We identified the number of patients who may eventually require surgery from a prospective cohort of patients with newly diagnosed epilepsy. We identified all U.K. neurosurgeons who had performed any epilepsy surgery in the past year. Each identified surgeon prospectively recorded the number and types of operations carried out for 6 months.


RESULTS
Of newly diagnosed patients each year, 450 (1.5%) may eventually require surgery. Thirty-two respondents (22% of all U.K. neurosurgeons) reported that they performed epilepsy surgery. The 211 operations were carried out in the 6 months surveyed (422 operations annually or 13 per surgeon per year). Temporal lobe resection (77%) was the most common procedure.


CONCLUSIONS
Based on a prevalence of 5/1,000 persons with epilepsy, < or =4,500 patients in the U.K. require epilepsy surgery. Every year, 450 patients with newly diagnosed epilepsy who may eventually require surgery are added to this "surgical pool." At the current annual rate of operations, a large number of refractory patients remain untreated. This is probably partly because many patients are not referred for specialist care and therefore remain underinvestigated.
Lhatoo
Samden D
SD
Department of Neurology, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol BS6 7AB, England, UK.
Solomon
Juliet K
JK
McEvoy
Andrew W
AW
Kitchen
Neil D
ND
Shorvon
Simon D
SD
Sander
Josemir W
JW
D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D018672:Community Health Planning / Q000706:statistics & numerical data; D003399:Craniotomy / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000453:epidemiology* / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data*; D009493:Neurosurgery / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013222:State Medicine / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology