title: Surgical treatment for epilepsy: the potential gap between evidence and practice.
abstract: Findings from randomised controlled trials, along with more than 100 case series and observational studies, support the efficacy and safety of resective surgery and, more recently, non-resective surgical interventions for the treatment of drug-resistant epilepsy in appropriately selected individuals. There is an argument that epilepsy surgery remains underused, but the evidence to support this assertion is at times unclear. Results from longitudinal studies show a stagnant or declining rate of epilepsy surgery over time, despite the evidence and guidelines supporting its use. Some suggest that this stagnation is due to a decreasing pool of eligible surgical candidates, whereas others emphasise the numerous barriers to epilepsy surgery. Strategies exist to increase access to surgery and to improve communication about the effectiveness of this potentially life-changing procedure. Further investigation into the nature and causes of the presumed underuse of epilepsy surgery and the elaboration of strategies to address this treatment gap are necessary and pressing.
authors.affiliation: Department of Clinical Neurosciences, Hotchkiss Brain Institute, Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jetté
authors.affiliation: UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK; Epilepsy Society, Chalfont St Peter, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands. Electronic address: l.sander@ucl.ac.uk.
authors.forename: Josemir W
authors.initials: JW
authors.lastname: Sander
authors.affiliation: UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK; Epilepsy Society, Chalfont St Peter, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montréal, QC, Canada.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Keezer
mesh_terms: D000818:Animals; D004827:Epilepsy / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D019635:Neurosurgical Procedures / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016896:Treatment Outcome