Development of an online tool to determine appropriateness for an epilepsy surgery evaluation.
OBJECTIVE
Despite evidence that epilepsy surgery is more effective than medical therapy, significant delays between seizure intractability and surgery exist. We aimed to develop a new Web-based methodology to assist physicians in identifying patients who might benefit from an epilepsy surgery evaluation.


METHODS
The RAND/UCLA appropriateness method was used. Clinical scenarios were developed based on eligibility criteria from previously published surgical series. Thirteen national experts rated the scenarios for their appropriateness for an epilepsy surgery evaluation based on published evidence. All scenarios were rerated after a face-to-face meeting following a modified Delphi process. Appropriate scenarios were rerated for necessity to determine referral priority.


RESULTS
Of the final 2646 scenarios, 20.6% (n = 544) were appropriate, 17.2% (n = 456) uncertain, and 61.5% (n = 1626) inappropriate for a surgical evaluation. Of the appropriate cases, 55.9% (n = 306) were rated as very high priority. Not attempting AED treatment was always rated as inappropriate for a referral. Trial of 2 AEDs was usually rated as appropriate unless seizure-free or not fully investigated Based on these data, a Web-based decision tool (www.epilepsycases.com) was created.


CONCLUSIONS
Using the available evidence through 2008 and expert consensus, we developed a Web-based decision tool that provides a guide for determining candidacy for epilepsy surgery evaluations. The tool needs clinical validation, and will be updated and revised regularly. This rendition of the tool is most appropriate for those over age 12 years with focal epilepsy. The Rand/UCLA appropriate methodology might be considered in the development of guidelines in other areas of epilepsy care.
Department of Clinical Neurosciences and Hotchkiss BrainInstitute, University of Calgary, Calgary, Alberta, Canada. nathalie.jette@albertahealthservices.ca
Nathalie
N
Jette
Hude
H
Quan
Jose F
JF
Tellez-Zenteno
Sophia
S
Macrodimitris
Walter J
WJ
Hader
Elisabeth M S
EM
Sherman
Lorie D
LD
Hamiwka
Elaine C
EC
Wirrell
Jorge G
JG
Burneo
Amy
A
Metcalfe
Peter D
PD
Faris
Lizbeth
L
Hernandez-Ronquillo
Churl-Su
CS
Kwon
Andrew
A
Kirk
Samuel
S
Wiebe
D001921:Brain / Q000601:surgery*; D032921:Consensus; D003657:Decision Making; D004827:Epilepsy / Q000601:surgery*; D006801:Humans; D020407:Internet; D019635:Neurosurgical Procedures