Reasons for not having epilepsy surgery

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Drug-resistant focal epilepsy affects a significant patient population.
• Presurgical evaluation is crucial for determining surgical candidacy.
• Many patients evaluated for epilepsy surgery do not ultimately undergo the procedure.

Purpose of the Study:

• To determine the reasons why adults with drug-resistant focal epilepsy do not proceed with surgery after presurgical evaluation.
• To identify predictors associated with the decision not to proceed with epilepsy surgery.

Main Methods:

• Retrospective analysis of 617 individuals evaluated for epilepsy surgery between 2015 and 2019.
• Comparison of characteristics between patients who did not proceed with surgery and those who underwent surgery.
• Multivariate logistic regression to identify predictors of not proceeding with surgery.

Main Results:

• 51% (315/617) of individuals did not proceed with surgery.
• Common reasons included inability to localize the epileptogenic zone (n=104) and multifocal epilepsy (n=74).
• Predictors for not proceeding with surgery included learning disability, normal MRI, extratemporal epilepsy, bilateral seizure onset, and socioeconomic deprivation.

Conclusions:

• Approximately half of patients evaluated for epilepsy surgery do not undergo the procedure.
• Early assessment of surgical suitability and the potential need for intracranial EEG (icEEG) can optimize presurgical evaluation referrals.
• Understanding reasons for non-surgical candidacy is vital for patient management in drug-resistant epilepsy.