Management of Patients with Refractory Temporal Lobe Epilepsy in North America and Europe
Abstract number :
3.314
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2204431
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Andreas Borta, MD, PhD – uniQure ; Bernd Schmidt, MD, PhD – Head of Neuro-Psych Clinic, Wittnau, Germany; Nuno Canas, MD, MSc – Refractory epilepsy Center, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Richard Porter, PhD – Corlieve Therapeutics SAS, a fully owned subsidiary of uniQure NV
Rationale: Resective epilepsy surgery is an irreversible procedure, associated with a long-term risk for postsurgical cognitive decline and disability. Few patients with refractory temporal lobe epilepsy (rTLE) are referred and evaluated for surgery at epilepsy monitoring units (EMUs) and, of those determined eligible, many end up declining it for various reasons. A survey was undertaken to get better insight into the management of these patients.
Methods: We surveyed EMUs in USA, Canada, and 13 European countries about the characteristics of patients with epilepsy and, in particular, rTLE and services provided to them, focusing on adult patients. The survey included 14 questions and was performed in 2021.
Results: The analysis included 20 respondents from North America (NA) and 46 from Europe (EU). The mean number of adult epilepsy patients evaluated per year was 329 in NA EMUs and 223 in EU. On average, 48 NA and 26 EU patients underwent surgery each year. Epilepsy centers in NA offered a broader spectrum of surgery techniques with laser ablation and responsive neurostimulation being offered at 95% of the sites, in comparison to only 12% and 8%, respectively, for the EU sites.
There was a difference in the pathologies seen at sites that evaluate > 300 (NA) or > 100 (EU) cases per year and sites with ≤ 300 (NA) or ≤ 100 (EU) cases. Larger sites reported 9% of adult patients with unilateral hippocampal sclerosis (HS), whereas smaller sites reported 13% (EU) to 16% (NA). Frequency of bilateral HS was overall quantified at 3% to 8%.
The most frequently used surgical techniques to treat rTLE patients with unilateral HS were lobectomy (NA: 45%, EU: 58%), lesionectomy (NA: 23%, EU: 38%), neurostimulation techniques (NA: 18%, EU: 12%) and laser ablation (NA: 31%, EU: 1%).
The mean proportion of rTLE cases in relation to all evaluated cases was 20% for NA and 30% for the EU on average. On average, only half of the patients with rTLE proceeded into resective surgery (52% at NA centers, 54% at EU centers). Overall, up to 18% of eligible patients declined resection surgery, their main reasons being overall fear of (brain) surgery and fear of post-surgical handicap. A quarter of the patients with rTLE were considered as not eligible for resection (26% at NA centers, 28% at EU centers). The most frequently mentioned medical reasons were non-concordant data (NA: 60%, EU: 91%) and failure in identifying the epileptic foci (NA: 45%, EU: 57%).
All centers offered vagus nerve stimulation as alternative therapy to resection. Further options included deep brain stimulation (NA: 95% of the centers, EU 35%), responsive neurostimulation (NA: 90%, EU: 4%), and ketogenic diet (NA: 45%, EU: 37%).
Conclusions: rTLE with hippocampal sclerosis was still seen at smaller EMUs in NA and EU whereas larger EMUs evaluated a broader variety of pathologies. Compared to EU, NA epilepsy centers offered more alternative treatment options, such as laser ablation and responsive neurostimulation.
Funding: This study was sponsored by Corlieve Therapeutics SAS, a fully owned subsidiary of uniQure N.V.
Surgery