Major Findings: After evidence-based recommendations were published, no significant trends were found suggesting earlier referral for epilepsy surgery evaluation.
Data Source: Retrospective, single-center comparison.
Disclosures: The investigators reported no relevant conflicts of interest.
BOSTON — The 2003 publication of evidence-based recommendations for referring patients with temporal lobe epilepsy for surgical evaluation has not led to an increase in timely referrals for appropriate candidates, according to a study of referral patterns.
Researchers at the Seizure Disorder Center of the David Geffen School of Medicine at the University of California, Los Angeles, compared data for patients seen in the center's epilepsy monitoring unit (EMU) before and after the American Academy of Neurology issued a practice parameter recommending referral for epilepsy surgery evaluation for patients who failed appropriate trials of first-line antiepileptic drugs (Neurology 2003;60:538-47).
Among 435 patients seen at the center during 1995-1998 and 712 patients seen during 2005-2008, those with brain tumors, previous EMU evaluations, or previous neurosurgery were excluded. This left 83 patients in the earlier period and 102 in the later period, Dr. Jerome Engel Jr. said at the annual meeting of the American Epilepsy Society.
No significant differences were found between the groups with respect to age at diagnosis, duration of epilepsy, or age at EMU evaluation, Dr. Engel reported. The mean age of onset was 17 years for the earlier group and 18.4 years for the latter group, the mean duration of epilepsy was 17.1 vs. 18.6 years, and the mean age at EMU evaluation was 34.1 vs. 37 years.
The findings confirm that the failure to refer patients with drug-resistant epilepsy continues to be a major problem, despite the availability of class I evidence for the effectiveness of surgery and evidence-based recommendations. As a result, patients who are surgical candidates—those whose seizures persist after appropriate trials of two antiepileptic drug regimens—continue to suffer debilitating seizures long after they might have if they had been referred to a surgical center according to the evidence-based guidelines, said Dr. Engel, director of the Seizure Disorder Center.
The UCLA investigators are conducting a critical review of factors that prevent the translation of recommendations for surgical referral in epilepsy to clinical practice.