Hakimi Andrea S, Spanaki Marianna V, Schuh Lori A, Smith Brien J, Schultz Lonni
Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA.
Epilepsy Behav. 2008 Jul;13(1):96-101. doi: 10.1016/j.yebeh.2008.02.003. Epub 2008 Mar 11.
There is a 20-year delay between the diagnosis of epilepsy and surgical treatment. The aim of this study was to describe the different views held by neurologists regarding refractory epilepsy that may contribute to the delay in referring patients for epilepsy surgery. Neurologists in Michigan were mailed a 10-item survey inquiring about their definition of medically refractory epilepsy and their decision-making process in referring patients for epilepsy surgery. Eighty-four neurologists responded (20%). The majority defined medically refractory epilepsy as failure of three monotherapy antiepileptic drug (AEDs) trials and at least two polytherapy trials. Nineteen percent responded that all approved AEDs had to fail before a patient could be defined as medically refractory. Eighty-two percent of the respondents had referred patients for epilepsy surgery. Almost 50% were not satisfied with the level of communication from epilepsy centers. One-third reported serious complications resulting from surgery. These findings suggest that further education and improved communication from comprehensive epilepsy centers may shorten the time to referral and ultimately improve the lives of patients with epilepsy.
癫痫诊断与手术治疗之间存在20年的延迟。本研究的目的是描述神经科医生对难治性癫痫的不同看法，这些看法可能导致将患者转介至癫痫手术的延迟。向密歇根州的神经科医生邮寄了一份包含10个项目的调查问卷，询问他们对药物难治性癫痫的定义以及将患者转介至癫痫手术时的决策过程。84位神经科医生回复（回复率为20%）。大多数人将药物难治性癫痫定义为三种单药抗癫痫药物（AEDs）试验失败以及至少两种联合治疗试验失败。19%的人回复称，在患者被定义为药物难治性之前，所有获批的AEDs都必须失败。82%的受访者曾将患者转介至癫痫手术。近50%的人对癫痫中心的沟通水平不满意。三分之一的人报告了手术导致的严重并发症。这些发现表明，来自综合癫痫中心的进一步教育和改善沟通可能会缩短转介时间，并最终改善癫痫患者的生活。
