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Surgery in intractable epilepsy—physicians' recommendations and patients' decisions
Author(s) -
Davids Roman,
Kowski Alexander B.,
Meencke HansJoachim,
Oltmanns Frank,
Dehnicke Christoph,
Schneider Ulf C.,
Holtkamp Martin
Publication year - 2021
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.13377
Subject(s) - medicine , epilepsy , aura , retrospective cohort study , multivariate analysis , epilepsy surgery , scalp , surgery , pediatrics , psychiatry , migraine
Objectives To identify demographic and clinical variables independently associated with patients' decisions against their physicians' recommendations for resective epilepsy surgery or further scalp video‐EEG monitoring (sca‐VEM), semi‐invasive (sem‐)VEM with foramen ovale and/or peg electrodes, and invasive (in‐)VEM. Methods Consecutive patients, who underwent presurgical assessment with at least one sca‐VEM between 2010 and 2014, were included into this retrospective analysis. Multivariate analysis was used to identify independent variables associated with patients' decisions. Results Within the study period, 352 patients underwent 544 VEM sessions comprising 451 sca‐, 36 sem‐, and 57 in‐VEMs. Eventually, 96 patients were recommended resective surgery, and 106 were ineligible candidates; 149 patients denied further necessary VEMs; thus, no decision could be made. After sca‐ or additional sem‐VEM, nine out of 51 eligible patients (17.6%) rejected resection. One hundred and ten patients were recommended in‐VEM, 52 of those (47.2%) declined. Variables independently associated with rejection of in‐VEM comprised intellectual disability (OR 4.721, 95% CI 1.047–21.284), extratemporal focal aware non‐motor seizures (“aura”) vs. no “aura” (OR 0.338, 95% CI 0.124–0.923), and unilateral or bilateral vs. no MRI lesion (OR 0.248, 95% CI 0.100–0.614 and 0.149, 95% CI 0.027–0.829, respectively). Conclusions During and after presurgical evaluation, patients with intractable focal epilepsy declined resections and intracranial EEGs, as recommended by their epileptologists, in almost 20% and 50% of cases. This calls for early and thorough counseling of patients on risks and benefits of epilepsy surgery. Future prospective studies should ask patients in depth for specific reasons why they decline their physicians' recommendations.