Ladino L D, Benjumea-Cuartas V, Vargas-Osorio J, Villamil-Osorio L V, Hernandez-Vanegas L, Martinez-Juarez I E, Tellez-Zenteno J F
University of Saskatchewan, Royal University Hospital , Saskatoon, Canada.
Programa de Epilepsia Hospital Pablo Tobon Uribe, Medellin, Colombia.
Rev Neurol. 2017 Sep 16;65(6):268-279.
Drug-resistant epilepsy, a chronic condition with long-term consequences can be treated with surgery. The efficacy and safety of surgery for temporal lobe epilepsy have been established through a large number of retrospective and prospective cohort studies and two randomized controlled clinical trials. Despite the excellent outcomes reported after surgery, the literature suggests that this procedure is an underutilized treatment. While evidence is lacking as to why epilepsy surgery is underused, cited reasons include: failure of primary care physicians and neurologists to provide information and identify patients who could be referred for surgery; different levels of technology at various centers, resulting in different candidate selection strategies; the belief that epilepsy surgery is a risky procedure and that it should be only viewed as the last option; patient preference to avoid surgery; parents wanting to wait until their child is old enough to participate in the decision-making process regarding surgery; unwillingness of insurers to cover the expenses associated with presurgical evaluations or lack of insurance; racial and social disparities, among others. In this paper we review the available epidemiological data about lack of utilization of epilepsy surgery.
耐药性癫痫是一种具有长期后果的慢性疾病，可通过手术进行治疗。颞叶癫痫手术的疗效和安全性已通过大量回顾性和前瞻性队列研究以及两项随机对照临床试验得以确立。尽管手术后报告了出色的结果，但文献表明该手术是一种未得到充分利用的治疗方法。虽然缺乏关于癫痫手术未得到充分利用原因的证据，但列举的原因包括：初级保健医生和神经科医生未能提供信息并识别可被转诊进行手术的患者；各中心技术水平不同，导致候选者选择策略各异；认为癫痫手术是一种有风险的手术，应仅被视为最后选择；患者倾向于避免手术；父母希望等到孩子足够大，能够参与有关手术的决策过程；保险公司不愿意承担与术前评估相关的费用或缺乏保险；种族和社会差异等。在本文中，我们回顾了有关癫痫手术未得到充分利用的现有流行病学数据。
