title: A screening tool to identify surgical candidates with drug refractory epilepsy in a resource limited settings.
abstract: OBJECTIVE
  Access to epilepsy surgery remains a considerable challenge in contemporary healthcare systems. Given the limitations in resources and demand for Epilepsy Monitoring Unit (EMU) assessments, information that can be used to expedite the process is of great value. The purpose of this study was to identify variables prior to EMU admission that may be associated with candidacy for prospective epilepsy surgery.
  
  
  METHODS
  This was a prospective study conducted at the Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. We identified two subgroups of patients from 501 drug refractory epilepsy (DRE) patients admitted in EMU of Neurology Department, AIIMS from 2006 onwards following validation of proposed tool in 40 patients. They on subsequent investigations were either cleared or not cleared for epilepsy surgery. A tool consisting of variables likely to predict surgical candidacy in persons with DRE in Indian settings was developed for identification of patients who might benefit from an early epilepsy surgery evaluation.
  
  
  RESULTS
  Statistical analysis revealed significant differences between the two groups for several variables. Non-surgical candidates had non-disabling seizures, seizures improved with a combination of drugs, had little/no AEDs side effects and had near normal or normal scalp EEG and MRI brain.
  
  
  CONCLUSIONS
  Using the best available evidence, we developed a decision making tool which can provide a comprehensive quick guide for determining candidacy for epilepsy surgery evaluations in resource limited settings. Given the demand for EMU assessments, information that can be used to expedite the process is of value.
authors: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
authors: Varun
authors: V
authors: Malhotra
authors: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors: Sarat P
authors: SP
authors: Chandra
authors: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
authors: Deepa
authors: D
authors: Dash
authors: Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
authors: Ajay
authors: A
authors: Garg
authors: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
authors: Madhavi
authors: M
authors: Tripathi
authors: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
authors: C S
authors: CS
authors: Bal
authors: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: manjari.tripathi@gmail.com.
authors: Manjari
authors: M
authors: Tripathi
mesh_terms: D000293:Adolescent; D002648:Child; D003657:Decision Making; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis* / Q000601:surgery; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007194:India; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D055815:Young Adult
keywords: Drug refractory epilepsy; Epilepsy; Ictal EEG; MRI; Presurgical evaluation