AANS Neurosurgeon | Volume 29, Number 2, 2020


Barriers to epilepsy surgery evaluation: Reports from physicians and patients

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Though the success rate of epilepsy surgery can be higher than 80% for certain seizure types, only a small fraction of people with drug-resistant epilepsy are referred for surgical evaluation.

To investigate the reasons behind provider nonreferral, as well as patient refusal of referral, a group at Charité University Hospital, Berlin, reviewed clinical checklists from the four outpatient epilepsy clinics tied to Germany’s Berlin-Brandenburg Epilepsy Center. Three of the clinics are at different campuses of Charité University Hospital; the fourth is at a nonacademic hospital.

The checklists are used to structure communication with patients about referrals for presurgical evaluation, including noninvasive video EEG monitoring. The center has no set protocol for discussing presurgical evaluation with patients, but presumes that conversations include at least the following information:

  • The expectation of an unfavorable seizure prognosis with continued AED treatment only
  • The risk of seizure-related injuries and SUDEP
  • The psychosocial consequences of drug-resistant epilepsy (driving, holding a job, etc.)
  • The benefits and risks of possible epilepsy surgery

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