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Experts in epilepsy care know that uncontrolled seizures result in poor quality of life and increase the risk of injuries and death. They also know that surgery is superior to medical therapy in carefully selected patients. On the other hand, publications from epilepsy centers around the world show that patients with surgically treatable epilepsy either are not referred or wait about 20 years before an evaluation for surgery. The long delay of potentially effective surgery occurs during the most formative years, when poorly controlled seizures have dire vocational and psychosocial consequences.
Clinical practice guidelines (CPG) aim to assist in clinical decision-making—particularly in situations of controversy or variation in practice. In 2003, the American Academy of Neurology published evidence-based CPGs endorsing at the strongest level (Level A) the referral of patients with drug-resistant complex partial seizures for surgical evaluation, and offering surgical treatment to those with temporal lobe epilepsy (TLE).1 Have …
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