Department of Clinical Neurosciences and Hotchkiss BrainInstitute, University of Calgary, Calgary, Alberta, Canada.
Neurology. 2012 Sep 11;79(11):1084-93. doi: 10.1212/WNL.0b013e3182698c4c. Epub 2012 Aug 15.
Despite evidence that epilepsy surgery is more effective than medical therapy, significant delays between seizure intractability and surgery exist. We aimed to develop a new Web-based methodology to assist physicians in identifying patients who might benefit from an epilepsy surgery evaluation.
The RAND/UCLA appropriateness method was used. Clinical scenarios were developed based on eligibility criteria from previously published surgical series. Thirteen national experts rated the scenarios for their appropriateness for an epilepsy surgery evaluation based on published evidence. All scenarios were rerated after a face-to-face meeting following a modified Delphi process. Appropriate scenarios were rerated for necessity to determine referral priority.
Of the final 2646 scenarios, 20.6% (n = 544) were appropriate, 17.2% (n = 456) uncertain, and 61.5% (n = 1626) inappropriate for a surgical evaluation. Of the appropriate cases, 55.9% (n = 306) were rated as very high priority. Not attempting AED treatment was always rated as inappropriate for a referral. Trial of 2 AEDs was usually rated as appropriate unless seizure-free or not fully investigated Based on these data, a Web-based decision tool (www.epilepsycases.com) was created.
Using the available evidence through 2008 and expert consensus, we developed a Web-based decision tool that provides a guide for determining candidacy for epilepsy surgery evaluations. The tool needs clinical validation, and will be updated and revised regularly. This rendition of the tool is most appropriate for those over age 12 years with focal epilepsy. The Rand/UCLA appropriate methodology might be considered in the development of guidelines in other areas of epilepsy care.
尽管有证据表明癫痫手术比药物治疗更有效，但癫痫发作的难治性与手术之间仍存在显著的延迟。我们旨在开发一种新的基于网络的方法，以帮助医生识别可能受益于癫痫手术评估的患者。
使用 RAND/UCLA 适宜性方法。根据先前发表的手术系列中的入选标准制定临床情况。13 名国家专家根据发表的证据对这些情况进行评估，以确定其是否适合进行癫痫手术评估。在经过修改的德尔菲程序的面对面会议之后，对所有情况进行重新评估。对适宜的情况进行重新评估，以确定转诊的必要性。
在最终的 2646 个情况中，20.6%（n=544）为适宜，17.2%（n=456）为不确定，61.5%（n=1626）为不适合手术评估。在适宜的病例中，55.9%（n=306）被评为高度优先。未尝试使用 AED 治疗总是被评为不适合转诊。除非患者无发作或未得到充分检查，否则尝试使用 2 种 AED 通常被评为适宜。基于这些数据，创建了一个基于网络的决策工具（www.epilepsycases.com）。
使用 2008 年之前的现有证据和专家共识，我们开发了一个基于网络的决策工具，为确定癫痫手术评估的候选资格提供了指导。该工具需要临床验证，并将定期更新和修订。该工具的这一版本最适合年龄在 12 岁以上、有局灶性癫痫的患者。RAND/UCLA 适宜性方法可能会在其他癫痫治疗领域的指南制定中得到考虑。
