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Evaluation for epilepsy surgery – Why do patients not proceed to operation?

Weber, Johan; Gustafsson, Cecilia; Malmgren, Kristina; Strandberg, Moa; Can, Ûmran; Compagno Strandberg, Maria LU and Kumlien, Eva (2019) In Seizure 69. p.241-244
Abstract

Purpose: To investigate the reasons for not proceeding to surgery in patients undergoing presurgical evaluation for epilepsy. Methods: A retrospective cohort study of 401 consecutive patients who were evaluated for but did not proceed to surgery for epilepsy between 1990 and 2016 at three Swedish epilepsy surgery centers was performed. Reasons for not proceeding to surgery were categorized as inconclusive investigation, seizure onset within eloquent cortex, evidence of multiple seizure foci, infrequent seizures, risk of postoperative severe cognitive decline, patient or caregiver declining surgery or invasive investigation, severe psychiatric or somatic comorbidity, patient death during evaluation and complications during the... (More)

Purpose: To investigate the reasons for not proceeding to surgery in patients undergoing presurgical evaluation for epilepsy. Methods: A retrospective cohort study of 401 consecutive patients who were evaluated for but did not proceed to surgery for epilepsy between 1990 and 2016 at three Swedish epilepsy surgery centers was performed. Reasons for not proceeding to surgery were categorized as inconclusive investigation, seizure onset within eloquent cortex, evidence of multiple seizure foci, infrequent seizures, risk of postoperative severe cognitive decline, patient or caregiver declining surgery or invasive investigation, severe psychiatric or somatic comorbidity, patient death during evaluation and complications during the evaluation. Chi-square tests were performed to compare ordered categorical variables. Results: During the entire time period the main reasons for rejection were inconclusive investigation (34,4%) and multifocal seizure onset (20,0%). The risk for severe cognitive decline postoperatively was more often a cause for rejection in more recent years. Patients declining invasive EEG or surgery accounted for a minor but not insignificant proportion (14,2%) of rejections. Conclusions: Inconclusive results from the presurgical evaluation and multifocal epilepsy were the main causes for not proceeding to surgery. The proportion of patients opting to abstain from surgery was low compared to other recent studies.

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author
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Epilepsy surgery, Nonoperated, Presurgical
in
Seizure
volume
69
pages
4 pages
publisher
Elsevier
external identifiers
  • scopus:85065761546
ISSN
1059-1311
DOI
10.1016/j.seizure.2019.05.004
language
English
LU publication?
no
id
6bea5a3d-2cfa-4c8e-8d19-b4eef6450a5a
date added to LUP
2019-05-28 08:40:18
date last changed
2019-06-19 04:13:54
@article{6bea5a3d-2cfa-4c8e-8d19-b4eef6450a5a,
  abstract     = {<p>Purpose: To investigate the reasons for not proceeding to surgery in patients undergoing presurgical evaluation for epilepsy. Methods: A retrospective cohort study of 401 consecutive patients who were evaluated for but did not proceed to surgery for epilepsy between 1990 and 2016 at three Swedish epilepsy surgery centers was performed. Reasons for not proceeding to surgery were categorized as inconclusive investigation, seizure onset within eloquent cortex, evidence of multiple seizure foci, infrequent seizures, risk of postoperative severe cognitive decline, patient or caregiver declining surgery or invasive investigation, severe psychiatric or somatic comorbidity, patient death during evaluation and complications during the evaluation. Chi-square tests were performed to compare ordered categorical variables. Results: During the entire time period the main reasons for rejection were inconclusive investigation (34,4%) and multifocal seizure onset (20,0%). The risk for severe cognitive decline postoperatively was more often a cause for rejection in more recent years. Patients declining invasive EEG or surgery accounted for a minor but not insignificant proportion (14,2%) of rejections. Conclusions: Inconclusive results from the presurgical evaluation and multifocal epilepsy were the main causes for not proceeding to surgery. The proportion of patients opting to abstain from surgery was low compared to other recent studies.</p>},
  author       = {Weber, Johan and Gustafsson, Cecilia and Malmgren, Kristina and Strandberg, Moa and Can, Ûmran and Compagno Strandberg, Maria and Kumlien, Eva},
  issn         = {1059-1311},
  keyword      = {Epilepsy surgery,Nonoperated,Presurgical},
  language     = {eng},
  pages        = {241--244},
  publisher    = {Elsevier},
  series       = {Seizure},
  title        = {Evaluation for epilepsy surgery – Why do patients not proceed to operation?},
  url          = {http://dx.doi.org/10.1016/j.seizure.2019.05.004},
  volume       = {69},
  year         = {2019},
}