Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Los Angeles, CA 90095-1769, USA.
Neurology. 2010 Aug 24;75(8):699-704. doi: 10.1212/WNL.0b013e3181eee457.
Class I evidence for surgical effectiveness in refractory temporal lobe epilepsy (TLE) in 2001 led to an American Academy of Neurology practice parameter in 2003 recommending "referral to a surgical epilepsy center on failing appropriate trials of first-line antiepileptic drugs." We examined whether this led to a change in referral patterns to our epilepsy center.
We compared referral data for patients with TLE at our center for 1995 to 1998 (group 1, n = 83) and 2005 to 2008 (group 2, n = 102) to determine whether these recommendations resulted in a change in referral patterns for surgical evaluation. Patients with brain tumors, previous epilepsy surgery evaluations, or brain surgery (including epilepsy surgery) were excluded.
We did not find a difference between the groups in the duration from the diagnosis of habitual seizures to referral (17.1 +/- 10.0 vs 18.6 +/- 12.6 years, p = 0.39) or the age at the time of evaluation (34.1 +/- 10.3 vs 37.0 +/- 11.8 years, p = 0.08). However, there was a difference in the distributions of age at evaluation (p = 0.03) and the duration of pharmacotherapy (p = 0.03) between the groups, with a greater proportion of patients in group 2 with drug-resistant epilepsy both earlier and later in their treatment course. Nonepileptic seizures were referred significantly earlier than TLE in either group or when combined.
Our analysis does not identify a significantly earlier referral for epilepsy surgery evaluation as recommended in the practice parameter, but suggests a hopeful trend in this direction.
2001 年，I 级证据证明手术治疗颞叶癫痫（TLE）有效，这导致 2003 年美国神经病学学会实践参数建议“在一线抗癫痫药物适当试验失败后，转至外科癫痫中心”。我们研究了这是否导致我们癫痫中心的转诊模式发生变化。
我们比较了我院 1995 年至 1998 年（第 1 组，n = 83）和 2005 年至 2008 年（第 2 组，n = 102）TLE 患者的转诊数据，以确定这些建议是否导致手术评估的转诊模式发生变化。排除脑肿瘤、既往癫痫手术评估或脑手术（包括癫痫手术）的患者。
我们没有发现两组患者从习惯性发作诊断到转诊的时间（17.1 ± 10.0 与 18.6 ± 12.6 年，p = 0.39）或评估时的年龄（34.1 ± 10.3 与 37.0 ± 11.8 年，p = 0.08）有差异。然而，两组在评估年龄分布（p = 0.03）和药物治疗持续时间（p = 0.03）方面存在差异，第 2 组中耐药性癫痫患者的比例在治疗过程中更早和更晚。无论是在组内还是组间，非癫痫性发作的转诊都明显早于 TLE。
我们的分析并未发现实践参数中建议的癫痫手术评估转诊明显提前，但表明这一趋势有希望。
