Recent developments: Recent developments in neurology (original) (raw)
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Epilepsy surgery, antiepileptic drug trials, and the role of evidence
Epilepsia, 2010
Objective: We assessed whether recent randomized controlled trials (RCTs) of antiepileptic drugs (AEDs) are informed by evidence about surgical effectiveness. We explored whether RCTs of AEDs consider the patients' candidacy for surgery in their eligibility criteria, and whether the necessary investigations are requested in participating patients to determine their potential eligibility for surgery. Methods: We systematically analyzed RCTs published in the last 2 years investigating the efficacy of new AEDs in localization-related epilepsy. Results from a surgical RCT and recommendations from an epilepsy surgery practice parameter were used to assess the degree to which surgical evidence informed the drug study design. Results: Eleven RCTs were analyzed. All were conducted in countries with access to epilepsy surgery. None of the studies required magnetic resonance imaging (MRI) with an epilepsy protocol or explicit statement of the epilepsy syndrome, which could lead to the identification of surgical candidates. Having temporal lobe epilepsy or being a potential surgical candidate were not exclusion criteria in any of the trials. The primary efficacy end point was the reduction in seizure frequency or responder rate. Seizure freedom was never the primary outcome, and it was reported in only seven studies. The pooled data analysis of these trials revealed that 1.9% of patients became seizurefree on placebo and 4.4% on the study drug (p < 0.01). Conclusions: Important aspects of patient selection for new AED trials are not informed by the evidence about surgical effectiveness. Investigations that could lead to identification of patients for presurgical evaluation were not required in any of the studies.
Effectiveness and safety of epilepsy surgery: what is the evidence?
CNS spectrums, 2004
Evidence from a recent randomized controlled trial of surgical versus medical therapy of temporal lobe epilepsy proves that antero-mesial resection is safe and more effective than medical therapy. The number of patients needed to treat for one patient to become free of disabling seizures is two, which is superior to most interventions in neurology. A meta-analysis of non-randomized trials gives almost identical results; about two-thirds of patients become seizure-free, compared with only 8% with medical therapy. The results are remarkably similar among studies from different parts of the world. Quality of life improves early after epilepsy surgery, the improvements are both statistically and clinically significant, and they are sustained. Surgical morbidity with clinically important permanent sequelae is 2%. Epilepsy surgery remains underutilized in developed countries and it does not exist in all but a few developing countries. Current randomized trials are underway to explore the ...
Epilepsy Surgery -A Short Update Review Article
Epilepsy surgery has been rapidly progressing over the last decade or so, with many previously untreatable conditions now satisfactorily managed to allow improved quality of life and seizure control without excessive medication and debilitating neurological deficits. We present a brief recap on accepted axioms of epilepsy surgery with a look at the future with a short summary of seizure disorder itself and the various management options.
Epilepsy surgery has been rapidly progressing over the last decade or so, with many previously untreatable conditions now satisfactorily managed to allow improved quality of life and seizure control without excessive medication and debilitating neurological deficits. We present a brief recap on accepted axioms of epilepsy surgery with a look at the future with a short summary of seizure disorder itself and the various management options. The article is directed at general physicians and Internalists who deal with epilepsy on a daily basis. Many have been exasperated by drug recalcitrant epilepsy and have tried with limited success to manage the condition medically. Many are not aware of the speciality of epilepsy surgery, which as mentioned above has made great strides in seizure control over the last decade. The piece also adds emphasis on diagnosis, seizure semiology and detection along with post procedure analysis and evaluation of efficacy. This has been added to assist the general physician in assessing the disease appropriately and referring the disease correctly to ensure proper diagnosis and treatment early. The authors hope that this piece helps sensitise the physicians to the existence of epilepsy surgery, so that they will refer their patient more and more to neurosurgeons for better care and results to their patients.
Epilepsy surgery: past, present and future
Seizure-european Journal of Epilepsy, 1998
Although epilepsy surgery has met with increased interest in recent years it is still underused in most countries, particularly third-world countries. Possible reasons for the recent expansion in epilepsy surgery in the so-called developed countries include the availability of advanced non-invasive diagnostic tools to delineate epileptogenic lesions and epilepsy-related functional deficits. and to prove 'epileptogenicity'. Improved surgical techniques are, however, equally important. This translates into better postsurgical outcome figures and into a larger population of difficult-to-treat patients profiting from surgical therapy. There is, also. an important role for epilepsy surgery within the modem neuroscience field. A critical review and analysis of the present state-of-the-art epilepsy surgery is presented and possible scenarios for its future development are outlined. Within this framework the conceptual differentiation of epilepsy surgery into three categories-'lesion-oriented surgery', 'epilepsy-oriented lesional surgery' and 'epilepsy surgery SEXISTS srr-icro'-is maintained, since it is relevant to the organization of epilepsy centres. The growing need for quality control and multidiiciplinary and worldwide collaboration is emphasized.