Abstracts

Rationale: Class I evidence for surgical effectiveness in refractory temporal lobe epilepsy (TLE) has been available since 2001 (1), leading to an AAN practice parameter in 2003 (2) recommending referral to a surgical epilepsy center on failing appropriate trials of first-line anti-epileptic drugs. We compared data in our epilepsy monitoring unit (EMU) for epochs approximately 10 years apart to examine if these recommendations resulted in earlier referrals for surgery. Methods: We retrospectively reviewed 435 EMU patients at UCLA between 1997-98 (group 1) and 712 EMU patients between 2004-2008 (group 2). Patients who had brain tumors, previous EMU evaluations, or neurosurgery (including epilepsy surgery ) were excluded , which yielded 85 group 1 patients and 132 group 2 patients diagnosed as TLE at discharge. The age of diagnosis was defined by the onset of the seizure pattern leading to evaluation. T-statistic was used to compare the groups. Results: Comparison of group 1 (1997-98) with group 2 (2004-08) did not reveal a significant difference in the age at diagnosis (16.7±12.4 vs. 18.6±11.4 yrs, p=0.25), the duration of epilepsy (17.2±10.0 vs. 17.5±12.7 yrs, p=0.86), or the age at the time of EMU evaluation (33.9±10.4 vs. 36.1±11.7 yrs, p=0.17) in TLE. Patients with NES were referred to the EMU significantly earlier (seizure duration 7.9±5.8 yrs) than patients with TLE (17.8±13 yrs, p<0.001). Conclusions: Our analysis does not reveal a trend towards earlier referral for surgery in TLE in the period after evidence-based recommendations were published. A critical review of the factors that prevent the translation of recommendations to clinical practice is in order. Our data add to the scarce literature on referral patterns for epilepsy surgery, and would be a basis for future comparisons. * REFERENCES * 1. Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001 Aug 2;345(5):311-8. 2. Engel J, Jr., Wiebe S, French J, Sperling M, Williamson P, Spencer D, et al. Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology. 2003 Feb 25;60(4):538-4