Abstracts

We investigated the referral practice of patients with intractable partial epilepsy to one comprehensive epilepsy center. All individuals subsequently underwent a surgical procedure for treatment of their seizure disorder. The rationale for this study was to identify the patient[apos]s state of residence, age at referral, duration of intractable epilepsy, and the physician referral pattern for epilepsy surgery. A retrospective study was performed using the Mayo Clinic epilepsy surgery database that includes all individuals who underwent treatment for a medically, physically, and socially disabling seizure disorder from December 1, 1987 to December 1, 1996. All patients were evaluated and treated at Mayo Clinic in Rochester, MN. 537 consecutive patients were identified who underwent a surgical procedure for intractable partial epilepsy during this period. The mean age was 32 years (range, 3-69 years). The mean age at seizure onset was 13 years (range, 0-65 years). The mean duration of epilepsy was 19 years (1-39 years). The state of residence could be identified in 442 patients. These individuals were from 34 states and the District of Columbia. Ten individuals were international patients. 378 patients (85%) were from the midwest, 37 patients (8%) from the south, 15 patients (3%) were from the west, and 3 patients ([lt]1%) from the northeast. The most frequent states of residence were Iowa (N=78), Minnesota (N=67), Michigan (N=51), Wisconsin (N=48), and Illinois (N=44). All patients were evaluated by a neurologist(s) prior to undergoing a presurgical evaluation in Rochester, MN. However, over 50% of the 537 patients were self-referred or referred by a non-neurologist to Mayo Clinic for epilepsy care. Common precipitating factors for referral included recent generalized tonic-clonic seizure, status epilepticus, loss of drivers license, physical trauma related to seizure, and antiepileptic drug toxicity. The long-term operative outcome (mean duration of 6 years) was available in 516 patients. 348 patients (67%) were seizure-free, 31 patients (6%) experienced rare and non-disabling seizures, 37 patients (7%) had [gt]80% reduction in seizures, and 100 patients (19%) were surgical failures. Patients with surgically remediable epileptic syndromes during this period were often not identified early in the course of medical treatment, even by the treating neurologist, despite an intractable seizure disorder. Frequently, the patient or primary care provider initiated the epilepsy evaluation after an adverse event. (Supported by Mayo Clinic College of Medicine and Mayo Foundation)