Nearly a third of people with epilepsy continue having seizures despite adequate trials of multiple antiseizure medications. Many of these individuals with medically refractory epilepsy benefit from various palliative and potentially curative surgical procedures. Although the number of centers offering surgery for epilepsy has increased dramatically in the last couple of decades, surgical treatment remains underutilized.
Kristen Arredondo, MD, and colleagues analyzed data from the National Association of Epilepsy Centers (NAEC) to determine how epilepsy center characteristics affected access to different types of epilepsy surgery and surgery volumes. The dataset included information from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors.
Arredondo and colleagues provide a wealth of useful information. Geographic location of the center, center accreditation level, institution type, demographics, and available resources influenced the access and the rates of potentially curative and palliative surgical interventions. The likelihood of undergoing potentially curative procedures (e.g., temporal lobectomy, extratemporal resection, hemispherectomy or hemispherotomy, and laser interstitial thermal therapy) was higher in centers with image-guided robotics and magnetoencephalography. Except for hemispherectomy and hemispherotomy, potentially curative procedures were more likely to occur in centers with a greater number of epilepsy specialists with at least two years of epilepsy fellowship training. Extratemporal resection, hemispherectomy, and hemispherotomy were all more likely to occur in pediatric centers than in adult centers, and hemispherectomy or hemispherotomy was only attempted in level 4 centers.
There are multiple reasons why surgical treatment of epilepsy is underutilized. Better understanding of the resources that make surgery for refractory epilepsy more feasible and the barriers that impede it may help us provide optimal care for more people.
Arredondo KH, Ahrens SM, Bagić AI, et al. on behalf of the NAEC Center Director Study Group. Association between characteristics of National Association of Epilepsy Centers and reported utilization of specific surgical techniques. Neurology 2023;100:e719-e727. https://doi.org/10.1212/WNL.0000000000201526