Predictors for being offered epilepsy surgery: 5-year experience of a tertiary referral centre.
OBJECTIVE
To define factors that predict whether patients with pharmacoresistant focal epilepsy are offered epilepsy surgery (including invasive EEG) and the main reasons for not proceeding with these after non-invasive presurgical evaluation.


METHODS
We retrospectively analysed data from 612 consecutive patients with focal epilepsy admitted to a video-EEG Telemetry Unit for presurgical evaluation, and used a multivariate logistic regression model to assess the predictive value of factors for being offered potentially curative surgery.


RESULTS
In the multivariate analysis, bilateral lesions on MRI (OR: 0.10; 95% CI 0.03 to 0.24), no lesion (OR: 0.33; 95% CI 0.22 to 0.49) or extratemporal lobe epilepsy (OR: 0.30; 95% CI 0.20 to 0.45) were the only factors that significantly reduced the probability of being offered surgery. 32% of patients who were offered epilepsy surgery decided against proceeding.


CONCLUSIONS
There was a low chance (<10%) of being offered surgery if there were bilateral lesions on MRI and extratemporal lobe epilepsy. Patients should be given advice on the risk/benefit ratio and of realistic outcomes of epilepsy surgery; this may help reduce the number of patients who refuse surgery after comprehensive workup.
UCL Institute of Neurology, UCL, London, UK Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK.
Chiara
C
Fois
UCL Institute of Neurology, UCL, London, UK Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK Department of Neurology, University of Muenster, Muenster, Germany.
Stjepana
S
Kovac
UCL Institute of Neurology, UCL, London, UK.
Aytakin
A
Khalil
Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK Department of Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey.
Gülnur Tekgöl
GT
Uzuner
UCL Institute of Neurology, UCL, London, UK Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK.
Beate
B
Diehl
UCL Institute of Neurology, UCL, London, UK Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK.
Tim
T
Wehner
UCL Institute of Neurology, UCL, London, UK Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK.
John S
JS
Duncan
UCL Institute of Neurology, UCL, London, UK Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK.
Matthew C
MC
Walker
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D007258:Informed Consent; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D013686:Telemetry; D062606:Tertiary Care Centers; D055815:Young Adult
EPILEPSY, SURGERY; NEUROSURGERY; TELEMETRY