Surgery for epilepsy

Purpose of Assessment

To provide an overview of the epidemiology, methods for diagnosis, and status of surgical treatment for epilepsy in Sweden and make recommendations.

Methods

Systematic review, cost analysis.

Review process for the publication

Internal review by project group, SBU Board and SBU Expert Group. Additional external review by experts in the field.

Content of Report

About 5–10% of Swedes will, at some time, experience a suspected epileptic seizure that is investigated. About 70% of the 100,000 Swedes with repeated seizures take pharmaceuticals for seizure control. In many cases this medication is inadequate and has severe side effects.

Recommendations/Conclusions

In cases where seizures cannot be controlled by medication, neurosurgery is considered. There are no scientifically rigorous studies of surgical treatment for epilepsy, but based on clinical experience, results of surgery are found to be good or very good.

Regardless of the type of treatment, epilepsy patients require extensive habilitation, rehabilitation, and social support.

Surgical treatment of epilepsy requires a well integrated, specialized team of personnel including neurologists, neurosurgeons, neuropsychiatrists, social workers, occupational therapists, and remedial teachers, all with special training in epilepsy.

Further resources should be allocated to the treatment of epilepsy in Sweden. There is a large need for the investigation and specialized treatment of epilepsy. Approximately 100 additional patients per year should be investigated for possible epilepsy surgery in Sweden. All cases of epilepsy that have not become seizure-free following traditional therapy should be investigated at the regional level within a neurology subspecialty. About one half of serious epilepsy cases investigated at a specialized department are suitable for surgical treatment.

Resources for epilepsy surgery should be increased at a center with specialized knowledge to operate on at least 15–20 cases per surgical team per year and not more than 30 cases as a maximum load. The goal for additional resources should be up to four centers for investigation and three centers for surgery at regional hospitals. Habilitation and rehabilitation resources must also be provided for cases not suited for surgery.

It is important that neuropediatrics and pediatrics rehabilitation resources are well established in Sweden because a large proportion of patients eligible for investigation and surgery are children.

It is desirable to dedicate more research to epilepsy, particularly for children.