Decision-making in temporal lobe epilepsy surgery: the contribution of basic non-invasive tests.
OBJECTIVE
We studied the extent to which the widely used diagnostic tests contribute to the decision whether or not to perform temporal lobe epilepsy (TLE) surgery in The Netherlands.


METHODS
This nation-wide, retrospective study included 201 consecutive patients referred for TLE surgery screening. The individual and combined contribution of nine index tests to the consensus decision to perform surgery was investigated. The contribution of each test was quantified using multivariable logistic regression and ROC curves.


RESULTS
Surgery was performed in 119 patients (59%). Patient history and routine EEG findings were hardly contributory to decision-making, whereas a convergence of MRI with long-term interictal and ictal EEG findings correctly identified the candidates considered eligible for surgery (25% of total). Videotaped seizure semiology contributed less to the results. The area under the ROC curve of the combination of basic tests was 0.75. Ineligibility was never accurately predicted with any test combination.


CONCLUSIONS
In the Dutch presurgical work-up, when MRI and long-term EEG findings were concordant, a decision for TLE surgery could be reached without further ancillary tests. Videotaped seizure semiology contributed less than expected to the final clinical decision. In our study, basic test findings alone were insufficient to exclude patients from surgery.
Uijl
Sabine G
SG
Rudolf Magnus Institute of Neuroscience and University Medical Center Utrecht, Department of Clinical Neurophysiology, Huispost F02.230, UMC Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Leijten
Frans S S
FS
Arends
Johan B A M
JB
Parra
Jaime
J
van Huffelen
Alexander C
AC
Moons
Karel G M
KG
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D003627:Data Interpretation, Statistical; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000523:psychology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures; D049268:Positron-Emission Tomography; D012372:ROC Curve; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014743:Videotape Recording