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Abstract
Introduction Despite the success of epilepsy surgery, recent reports suggest a decline in surgical numbers. We tested these trends in our cohort to elucidate potential reasons.
Patients and methods Presurgical, surgical and postsurgical data of all patients undergoing presurgical evaluation in between 1990 and 2013 were retrospectively analysed. Patients were grouped according to the underlying pathology.
Results A total of 3060 patients were presurgically studied, and resective surgery was performed in 66.8% (n=2044) of them: medial temporal sclerosis (MTS): n=675, 33.0%; benign tumour (BT): n=408, 20.0%; and focal cortical dysplasia (FCD): n=284, 13.9%. Of these, 1929 patients (94.4%) had a follow-up of 2 years, and 50.8% were completely seizure free (Engel IA). Seizure freedom rate slightly improved over time. Presurgical evaluations continuously increased, whereas surgical interventions did not. Numbers for MTS, BT and temporal lobe resections decreased since 2009. The number of non-lesional patients and the need for intracranial recordings increased. More evaluated patients did not undergo surgery (more than 50% in 2010–2013) because patients were not suitable (mainly due to missing hypothesis: 4.5% in 1990–1993 up to 21.1% in 2010–2013, total 13.4%) or declined from surgery (maximum 21.0% in 2010–2013, total 10.9%). One potential reason may be that increasingly detailed information on chances and risks were given over time.
Conclusions The increasing volume of the presurgical programme largely compensates for decreasing numbers of surgically remediable syndromes and a growing rate of informed choice against epilepsy surgery. Although comprehensive diagnostic evaluation is offered to a larger group of epilepsy patients, surgical numbers remain stable.
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Footnotes
Contributors TC involved in collection, analysis and interpretation of the data, and drafting the manuscript and figures. TWM involved in analysis and interpretation of the data, statistical analyses and revision of the manuscript for important intellectual content. IB commented on neuropathological data and revised the manuscript for content. PG participated in collection of clinical data, revision of the manuscript for content and database work. LJH involved in collection of clinical data, database and revision of the manuscript for content. TK provided neurosurgical comments and participated in data collection for outcome and revision of the manuscript for content. MP participated in collection of clinical data, database and revision of the manuscript for content. TP and RS revised the manuscript for important intellectual content. FGW set up structure for data collection on neuroimaging and revised the manuscript for important intellectual content. CGB provided important conceptional influence and revised the manuscript for important conceptual and intellectual content.
Funding The work is supported by the European Union (FP7 DESIRE GA # 602531 to IB).
Competing interests TWM received financial support from UCB (Monheim, Germany) and Desitin (Hamburg, Germany) for visiting scientific meetings, served on scientific advisory boards and received honoraria for speaking engagements from Eisai (Frankfurt, Germany), UCB and Desitin. RS reports personal fees from UCB (Monheim Germany), outside the submitted work. CGB reports personal fees and other from Eisai (Frankfurt, Germany), UCB (Monheim, Germany) and Desitin (Hamburg, Germany), grants and personal fees from Grifols (Frankfurt, Germany), Diamed (Köln, Germany) and Fresenius Medical Care (Bad Homburg, Germany), outside the submitted work.
Provenance and peer review Not commissioned; externally peer reviewed.