Abstracts

Rationale: It is generally accepted that the prevalence of epilepsy is, approximately, 0,5% of the population in the developed countries, and that it is medically refractory in a third of the cases. On the other hand, it has been estimated that up to 25% of the refractory patients could benefit from surgical treatment, and that 70% of those who undergo presurgical evaluations could be operated on. Therefore, a 0,03% of the population might eventually have epilepsy surgery. However, most of the data on this topic come from referral hospitals, while little is known about the real figures in the primary settings of the healthcare system. Methods: We have retrospectively analyzed the fate of the patients with refractory epilepsy who were offered to be referred for presurgical evaluation and eventually surgery to another hospital, between july 1996 and june 2006. The study was done at the Neurology Department of the Hospital Xeral in Vigo (NW Spain). Our hospital belongs to the National Health System and has a catchment area of 250.000 population, although only people over 14 years of age (170.000 approximately) can be seen in our department. Given that health care coverage is universal and free of charge in our country, most of the people use the public system for these purposes.Results: A total of 48 patients with refractory epilepsy were considered as candidates for epilepsy surgery after a clinical evaluation which included an MRI study. Only 25 patients (16 initially, and other 9 after repeated offers) accepted the proposal, which was later rejected by 2 of them. At present, only 6 patients have had epilepsy surgery (one of them in a private hospital). Another 7 patients have not been considered good surgical candidates after presurgical studies, while 10 patients are still undergoing presurgical evaluation.Conclusions: Even if all the patients under presurgical evaluation were eventually operated on, the rate of epilepsy surgery in our setting would be less than a third of the published estimations. This low figure would be mainly explained by the high degree of rejection of this type of surgery by patients.