Departments of Neurology, Neurobiology and Psychiatry and Biobehavioral Sciences and the Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Curr Opin Neurol. 2018 Apr;31(2):192-197. doi: 10.1097/WCO.0000000000000528.
Three randomized controlled trials demonstrate that surgical treatment is safe and effective for drug-resistant epilepsy (DRE), yet fewer than 1% of patients are referred for surgery. This is a review of recent trends in surgical referral for DRE, and advances in the field. Reasons for continued underutilization are discussed.
Recent series indicate no increase in surgical referral for DRE over the past two decades. One study suggests that decreased referrals to major epilepsy centers can be accounted for by increased referrals to low-volume nonacademic hospitals where results are poorer, and complication rates higher. The increasing ability of high-resolution MRI to identify small neocortical lesions and an increase in pediatric surgeries, in part, explain a relative greater decrease in temporal lobe surgeries. Misconceptions continue to restrict referral. Consequently, advocacy for referral of all patients with DRE to epilepsy centers that offer specialized diagnosis and other alternative treatments, as well as psychosocial support, is recommended. Recent advances will continue to improve the safety and efficacy of surgical treatment and expand the types of patients who benefit from surgical intervention.
Surgical treatment for epilepsy remains underutilized, in part because of persistent misconceptions. Rather than promote referral for surgery, it would be more appropriate to advocate that all patients with DRE deserve a consultation at a full-service epilepsy center that offers many options for eliminating or reducing disability.
三项随机对照试验表明，手术治疗耐药性癫痫（DRE）是安全有效的，但只有不到 1%的患者被转介进行手术。本文回顾了 DRE 手术转介的最新趋势和该领域的进展，讨论了持续利用率低的原因。
过去二十年，DRE 的手术转介没有增加。一项研究表明，主要癫痫中心的转诊减少可以归因于向低容量的非学术医院的转诊增加，这些医院的结果较差，并发症发生率较高。高分辨率 MRI 识别小皮质病变的能力增强，以及儿科手术的增加，在一定程度上解释了颞叶手术相对减少的原因。误解仍然限制了转介。因此，建议向提供专门诊断和其他替代治疗方法以及社会心理支持的癫痫中心转介所有 DRE 患者，以提高手术治疗的安全性和有效性，并扩大受益于手术干预的患者类型。
癫痫的手术治疗仍然未得到充分利用，部分原因是存在持续的误解。与其提倡手术转诊，不如提倡所有 DRE 患者都应在提供多种消除或减少残疾方法的全面癫痫中心进行咨询。
