PDF(Pubmed)
Abstract：
Epilepsy surgery is the treatment of choice for patients with drug-resistant seizures. A timely evaluation for surgical candidacy can be life-saving for patients who are identified as appropriate surgical candidates, and may also enhance the care of nonsurgical candidates through improvement in diagnosis, optimization of therapy, and treatment of comorbidities. Yet, referral for surgical evaluations is often delayed while palliative options are pursued, with significant adverse consequences due to increased morbidity and mortality associated with intractable epilepsy. The Surgical Therapies Commission of the International League Against Epilepsy (ILAE) sought to address these clinical gaps and clarify when to initiate a surgical evaluation. We conducted a Delphi consensus process with 61 epileptologists, epilepsy neurosurgeons, neurologists, neuropsychiatrists, and neuropsychologists with a median of 22 years in practice, from 28 countries in all six ILAE world regions. After three rounds of Delphi surveys, evaluating 51 unique scenarios, we reached the following Expert Consensus Recommendations: (1) Referral for a surgical evaluation should be offered to every patient with drug-resistant epilepsy (up to 70 years of age), as soon as drug resistance is ascertained, regardless of epilepsy duration, sex, socioeconomic status, seizure type, epilepsy type (including epileptic encephalopathies), localization, and comorbidities (including severe psychiatric comorbidity like psychogenic nonepileptic seizures [PNES] or substance abuse) if patients are cooperative with management; (2) A surgical referral should be considered for older patients with drug-resistant epilepsy who have no surgical contraindication, and for patients (adults and children) who are seizure-free on 1-2 antiseizure medications (ASMs) but have a brain lesion in noneloquent cortex; and (3) referral for surgery should not be offered to patients with active substance abuse who are noncooperative with management. We present the Delphi consensus results leading up to these Expert Consensus Recommendations and discuss the data supporting our conclusions. High level evidence will be required to permit creation of clinical practice guidelines.
摘要：
癫痫手术是耐药性癫痫患者的首选治疗方法。及时评估手术候选人资格可以挽救被确定为适当手术候选人的患者的生命，也可以通过改善诊断来加强非手术候选人的护理，优化治疗，和合并症的治疗。然而，在寻求姑息治疗方案的同时，手术评估的转诊通常会延迟，由于与难治性癫痫相关的发病率和死亡率增加，导致严重的不良后果。国际抗癫痫联盟（ILAE）的手术治疗委员会试图解决这些临床差距，并澄清何时开始手术评估。我们与61位癫痫学家进行了Delphi共识过程，癫痫神经外科医生，神经学家,神经精神科医生,和神经心理学家的中位数为22年，来自所有六个ILAE世界区域的28个国家。经过三轮德尔福调查，评估51个独特的场景，我们达成了以下专家建议共识：（1）应向每位耐药癫痫患者（70岁以下）提供手术评估转诊，一旦确定耐药性，不管癫痫的持续时间，性别,社会经济地位,癫痫发作类型,癫痫类型（包括癫痫性脑病），本地化,和合并症（包括严重的精神病合并症，如精神性非癫痫发作[PNES]或药物滥用），如果患者与管理合作；（2）对于没有手术禁忌症的老年耐药癫痫患者，应考虑手术转诊，以及使用1-2种抗癫痫药物（ASM）但无癫痫发作的患者（成人和儿童）；（3）不配合治疗的活性物质滥用患者不应转诊手术。我们提出了导致这些专家共识建议的Delphi共识结果，并讨论了支持我们结论的数据。需要高水平的证据才能允许制定临床实践指南。
