Referral pattern for epilepsy surgery after evidence-based recommendations: a retrospective study.
BACKGROUND
Class I evidence for surgical effectiveness in refractory temporal lobe epilepsy (TLE) in 2001 led to an American Academy of Neurology practice parameter in 2003 recommending "referral to a surgical epilepsy center on failing appropriate trials of first-line antiepileptic drugs." We examined whether this led to a change in referral patterns to our epilepsy center.


METHODS
We compared referral data for patients with TLE at our center for 1995 to 1998 (group 1, n = 83) and 2005 to 2008 (group 2, n = 102) to determine whether these recommendations resulted in a change in referral patterns for surgical evaluation. Patients with brain tumors, previous epilepsy surgery evaluations, or brain surgery (including epilepsy surgery) were excluded.


RESULTS
We did not find a difference between the groups in the duration from the diagnosis of habitual seizures to referral (17.1 +/- 10.0 vs 18.6 +/- 12.6 years, p = 0.39) or the age at the time of evaluation (34.1 +/- 10.3 vs 37.0 +/- 11.8 years, p = 0.08). However, there was a difference in the distributions of age at evaluation (p = 0.03) and the duration of pharmacotherapy (p = 0.03) between the groups, with a greater proportion of patients in group 2 with drug-resistant epilepsy both earlier and later in their treatment course. Nonepileptic seizures were referred significantly earlier than TLE in either group or when combined.


CONCLUSIONS
Our analysis does not identify a significantly earlier referral for epilepsy surgery evaluation as recommended in the practice parameter, but suggests a hopeful trend in this direction.
Haneef
Zulfi
Z
Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Los Angeles, CA 90095-1769, USA.
Stern
John
J
Dewar
Sandra
S
Engel
Jerome
J
D000328:Adult; D017677:Age Distribution; D004827:Epilepsy / Q000188:drug therapy / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy / Q000601:surgery*; D019317:Evidence-Based Medicine; D006287:Health Planning Guidelines; D006801:Humans; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000592:standards* / Q000639:trends*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012017:Referral and Consultation / Q000639:trends*; D012189:Retrospective Studies