The Changing Landscape of Epilepsy Surgery …az9194.vo.msecnd.net/pdfs/131202/20101 French...
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The Changing Landscape of Epilepsy Surgery
December 7, 2013
Jacqueline A French MD
Comprehensive Epilepsy Center
NYU School of Medicine
American Epilepsy Society | Annual Meeting
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The Changing Landscape of Epilepsy Surgery
December 7, 2013
Jacqueline A French MD
Comprehensive Epilepsy Center
NYU School of Medicine
American Epilepsy Society | Annual Meeting
![Page 6: The Changing Landscape of Epilepsy Surgery …az9194.vo.msecnd.net/pdfs/131202/20101 French ARS...The Changing Landscape of Epilepsy Surgery December 7, 2013 Jacqueline A French MD](https://reader030.fdocuments.us/reader030/viewer/2022040811/5e5477f6c9521448a162058b/html5/thumbnails/6.jpg)
Brewer K, Sperling M J. Neurosci Nurs 1988 20(6):366-72 Cahan LD, Engel J jr Acta Neurol Scand 1986 73(6):551-60 Hudson LP et al, Ann Neurol 1993 33(6):622-31 Devinsky O, Pacia S, Neurol Clin 1993, 11(4):951-71 Porter, RJ, Sato, S in: Epilepsy Surgery, Hans Luders, ed, Raven Press LTD NY 1991,pp 105-10 Spencer DD, Inserni J in:Epilepsy Surgery, Hans Luders, ed, Raven Press LTD NY 1991,pp 533-46
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Surgery Type Number (%) of surgeries performed
Totals
Anterior Temporal lobectomy
4862 (59%) 66%
Amygdalohippocamp- ectomy
568 (7%)
Lesionectomy 440 (5%) 5%
Extratemporal resection 1073 (13%)
18% Hemispherectomy and Large Lobar Resections
448 (5%)
Corpus Callosotomy 843 (10%) 10%
Number of Surgeries performed worldwide between 1986-1990
Engel J Jr, Shewmon DA. In: Engel J Jr ed, Surgical Treatment of the Epilepsies, 2nd ed, New York, Raven Press, 1993: 23-4
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Are Times Changing?
• IS Temporal lobe epilepsy still the most common type of epilepsy?
• IS Temporal Lobectomy still the most common surgery?
• IS epilepsy surgery overall rising or falling in utilization?
• If the landscape is changing, how would we know?
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Are Times Changing?
To determine whether physicians felt that MTLE was still the most common type of surgical
candidate, we used the new “Q-PULSE” mechanism
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Intro to Q-Pulse
• New AES effort • 2 epileptologists invited from every NAEC
epilepsy center make up q-pulse panel – Each filled out a survey providing demographics (age,
pediatric vs adult, years in practice, primary interest, geographic location)
• Q-Pulse questions pushed to panel via Survey Monkey
• All responses anonymized, but demographics can be linked with responses
• We received 97 replies to the survey
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At your center, how many of the treatment resistant epilepsy patients have mesial temporal lobe epilepsy?
10-50% (the
minority)
<10 % a
small
minority)
<1% (very
few)
The
majority
Don't know
*No-one endorsed “all patients” or “no patients”
51% 35%
11%
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Compared to 10 years ago, your epilepsy center sees____pts with mesial temporal lobe epilepsy
Less
Not
practicin
g then but
less
more
Not
practicin
g then but
more
Don’t
know
64% 2%
16%
10%
8 %
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If the landscape is changing, how can we know for sure?
• Epilepsy centers may behave in different ways:
– They may elect to perform only temporal lobe surgeries
• In this case, the absolute number of surgeries at the center might fall, but the percent of the total made up of TLE would not change
– They may attempt to perform increasing number of neocortical surgeries
• In this case the absolute number of surgeries at a center may stay the same,rise or fall, but the percent of temporal lobectomies would fall
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Absolute number of surgeries in Bonn Epilepsy program
Bien et al Trends in presurgical evaluation and surgical treatment of epilepsy at one centre from 1988–2009 J Neurol Neurosurg Psychiatry 2013 vol. 84 no. 1 54-61
Presurgical evaluations
Surgeries performed
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Four most common surgeries in Bonn
Bien et al Trends in presurgical evaluation and surgical treatment of epilepsy at one centre from 1988–2009 J Neurol Neurosurg Psychiatry 2013 vol. 84 no. 1 54-61
Absolute numbers of surgeries (Each type)
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Symposium • Who was I treating then? Who am I treating now?
– Dennis Spencer MD
• The Changing Surgical Landscape in Kids – Howard Weiner MD
• What Is the Evidence that the Landscape is Changing?
Theories of Change – Dale Hesdorffer PhD
• Perspective of Basic Science: Is There Life Outside the Hippocampus? – Jeffrey Loeb MD, PhD
• Where do we go from here? – Jacqueline French MD