What is the current evidence on decision-making after referral for temporal lobe epilepsy surgery? A review of the literature.
OBJECTIVE
Many patients thought to have temporal lobe epilepsy, are evaluated for surgical treatment. Decision-making in epilepsy surgery is a multidisciplinary, phased process involving complex diagnostic tests. This study reviews the literature on the value of different tests to decide on whether to operate.


METHODS
Articles were selected when based on the consensus decision whether to perform temporal lobe surgery, or on the consensus localization or lateralization of the epileptic focus. The articles were scrutinized for sources of bias as formulated in methodological guidelines for diagnostic studies (STARD).


RESULTS
Most studies did not fulfill the criteria, largely because they addressed prognostic factors in operated patients only. Ten articles met our inclusion criteria. In most articles, a single test was studied; SPECT accounted for five papers. Unbiased comparison of the results was not possible.


CONCLUSIONS
Surprisingly little research in epilepsy surgery has focused on the decision-making process as a whole. Future studies of the added value of consecutive tests are needed to avoid redundant testing, enable future cost-efficiency analyses, and provide guidelines for diagnostic strategies after referral for temporal lobe epilepsy surgery.
Uijl
Sabine G
SG
Rudolf Magnus Institute for Neuroscience, Department of Clinical Neurophysiology, hp F02.230, UMC Utrecht, P.O. Box 85500, The Netherlands.
Leijten
Frans S S
FS
Parra
Jaime
J
Arends
Johan B A M
JB
van Huffelen
Alexander C
AC
Moons
Karel G M
KG
D003657:Decision Making / Q000502:physiology*; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D009493:Neurosurgery / Q000379:methods*; D012196:Review Literature as Topic; D016896:Treatment Outcome