TY - JOUR
T1 - Epilepsy surgery in the United States
T2 - Analysis of data from the National Association of Epilepsy Centers
AU - Kaiboriboon, Kitti
AU - Malkhachroum, Ayham M.
AU - Zrik, Ahmad
AU - Daif, Ahmad
AU - Schiltz, Nicholas M.
AU - Labiner, David M.
AU - Lhatoo, Samden D.
N1 - Funding Information:
The authors would like to sincerely thank the National Association of Epilepsy Centers for sharing and allowing analysis of their data. Drs. Kaiboriboon and Lhatoo received support from the Centers for Disease Control and Prevention (Grant no. 3U48DP001930 ). Dr. Lhatoo received support from the National Institute of Neurological Disorders and Stroke (Grant no. P20NS076965 ).
Publisher Copyright:
© 2015 Elsevier B.V.
Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Objective: To examine trends in epilepsy-related surgical procedures performed at major epilepsy centers in the US between 2003 and 2012, and in the service provision infrastructure of epilepsy centers over the same time period. Methods: We analyzed data from the National Association of Epilepsy Centers' (NAEC) annual surveys. The total annual figures, annual average figures per center and annual rates of each surgical procedure based on US population numbers for that year were calculated. Additional information on center infrastructure and manpower was also examined. Results: The number of the NAEC's level 3 and level 4 epilepsy centers submitting annual survey reports increased from 37 centers in 2003 to 189 centers in 2012. The average reported number of Epilepsy Monitoring Unit (EMU) beds per center increased from 7 beds in 2008 to 8 beds in 2012. Overall annual EMU admission rates doubled between 2008 and 2012 but the average number of EMU admissions and epilepsy surgeries performed per center declined over the same period. The annual rate of anterior temporal lobectomies (ATL) for mesial temporal sclerosis (MTS) declined by >65% between 2006 and 2010. The annual rate of extratemporal surgery exceeded that of ATL for MTS from 2008 onwards, doubled between 2007 and 2012 and comprised 38% of all resective surgeries in 2012. Vagus nerve stimulator implant rates consistently increased year on year and exceeded resective surgeries in 2011 and 2012. Conclusion: The last decade has seen a major change in the US epilepsy surgery landscape. Temporal lobectomies, particularly for MTS, have declined despite an increase in EMU admissions. On the other hands, case complexity correspondingly increased as evidenced by more extratemporal surgery, intracranial recordings and palliative procedures.
AB - Objective: To examine trends in epilepsy-related surgical procedures performed at major epilepsy centers in the US between 2003 and 2012, and in the service provision infrastructure of epilepsy centers over the same time period. Methods: We analyzed data from the National Association of Epilepsy Centers' (NAEC) annual surveys. The total annual figures, annual average figures per center and annual rates of each surgical procedure based on US population numbers for that year were calculated. Additional information on center infrastructure and manpower was also examined. Results: The number of the NAEC's level 3 and level 4 epilepsy centers submitting annual survey reports increased from 37 centers in 2003 to 189 centers in 2012. The average reported number of Epilepsy Monitoring Unit (EMU) beds per center increased from 7 beds in 2008 to 8 beds in 2012. Overall annual EMU admission rates doubled between 2008 and 2012 but the average number of EMU admissions and epilepsy surgeries performed per center declined over the same period. The annual rate of anterior temporal lobectomies (ATL) for mesial temporal sclerosis (MTS) declined by >65% between 2006 and 2010. The annual rate of extratemporal surgery exceeded that of ATL for MTS from 2008 onwards, doubled between 2007 and 2012 and comprised 38% of all resective surgeries in 2012. Vagus nerve stimulator implant rates consistently increased year on year and exceeded resective surgeries in 2011 and 2012. Conclusion: The last decade has seen a major change in the US epilepsy surgery landscape. Temporal lobectomies, particularly for MTS, have declined despite an increase in EMU admissions. On the other hands, case complexity correspondingly increased as evidenced by more extratemporal surgery, intracranial recordings and palliative procedures.
KW - Epilepsy surgery
KW - Refractory epilepsy
KW - Temporal trends
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U2 - 10.1016/j.eplepsyres.2015.07.007
DO - 10.1016/j.eplepsyres.2015.07.007
M3 - Article
C2 - 26310969
AN - SCOPUS:84940546105
VL - 116
SP - 105
EP - 109
JO - Journal of Epilepsy
JF - Journal of Epilepsy
SN - 0920-1211
ER -