Abstracts

Rationale: 20-30% of epilepsy patients are refractory to medical therapy, and surgery becomes an option. The best seizure-free rates are seen with temporal lobe epilepsy (TLE), reaching 75%. CPS patients seen in neurology settings, specifically intractable cases of TLE, are not getting pre-surgical tests needed prior for surgical evaluation. Findings could lead to further education of patients and clinicians, providing surgical care to more TLE subjects. Methods: A retrospective chart review of patients with complex partial seizures (CPS). This chart review sought refractory TLE patients during the month of December 2008 in the Temple University Hospital neurology clinics or who received neurological testing. The epilepsy diagnosis codes 780.39 and 345.0-9 were evaluated. These patients were further divided into medically managed or intractable CPS. Completion of Brain MRI and EEG (routine and LTM studies)were evaluated. If data wasn't complete within clinic charts, they were located on the TUH radiology system (PACS) or the EEG database, respectively. These studies located on either PACS or EEG database were allowed in the study even if completed post December 2008. Exclusion criteria included patients’ who didn't have CPS as well as inpatients or incomplete charts. Those outpatients who had a clinical diagnosis of medically managed or intractable CPS were included, and analyzed regardless of whether the preliminary studies (brain MRI, routine EEG and LTM)were completed. Each subject could be scored on a 4 points, with the first point for the appropriate clinical diagnosis. They were rewarded an additional point for each test type (brain MRI, routine EEG and LTM, respectively). Those tests not done at this facility or results not found in the chart, PACS system or EEG database were not given points. Results: Out of 176 patients with the diagnosis codes of 780.39 and 345.0-9, 81 had outpatient files. Amongst 81 charts, 23 patients were given a diagnosis of CPS. Of 23 patients, 9 patients were documented to be intractable. Of the initial 14 with CPS, but no mention of intractability, 2 scored a 4, 9 scored a 3, and 3 scored a 2. Of the 9 intractable cases, 4 scored a 4, 3 scored a 3, and 2 scored a 2. In the CPS group 14% completed these 3 initial tests for surgical evaluation. In the intractable group, 44% of patients had test completion. Conclusions: This study showed that too few patients with a diagnosis of CPS, specifically intractable forms, the preliminary studies needed by a neurosurgeon to assess candidacy for surgery. Limitations included incomplete charts, inpatient studies in the initial numbers, and only one month of data. Some charts were eliminated due to lack of epilepsy localization. As well, factors precluding epilepsy, i.e. psychiatric issues such as psychosis or extensive suicide history weren't assessed. The overall findings suggest a need for further education for neurology clinicians when it comes to surgery for TLE.