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The treatment of epilepsy involves 4 modalities: medications, neurostimulation, diet, and surgery. The proportion of medically refractory patients remains around 30%, despite new medications, justifying the need for nondrug treatments. In fact, the use of nondrug treatments is one of the key roles of a comprehensive epilepsy center.
Acknowledgments
Acknowledgment: Data on VNS and epilepsy surgery cases were provided by the National Association of Epilepsy Centers (NAEC). These data were self-reported by NAEC level IV epilepsy centers, reflecting services provided in 2012. The authors thank Henian Chen, PhD, Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, for assistance with the statistical analysis; and authors of the opposing side for defending the skeptics' position.
Footnotes
Author contributions: Dr. Benbadis: original conceptualization, drafting, data collection and organization from NAEC, principal writing. Dr. Helmers: interpretation of the data, critical review of concepts and content, and editing. Dr. Hirsch: interpretation of the data, critical review of concepts and content, and editing. Dr. Sirven: interpretation of the data, critical review of concepts and content, and editing. Dr. Vale: critical review and input from surgical point of view, and editing. Dr. Wheless: interpretation of the data, critical review of concepts and content, and editing.
Study funding: No targeted funding reported.
Disclosure: S. Benbadis has served as a consultant for Cyberonics, Lundbeck, RSC Diagnostics, Sunovion, Supernus, UCB Pharma, and Upsher-Smith; is on the speakers' bureau for Cyberonics, GlaxoSmithKline, Lundbeck, Sunovion, Supernus, and UCB Pharma; has received grant support from Cyberonics, Lundbeck, Sepracor, Sunovion, Supernus, UCB Pharma, and Upsher-Smith; has received royalties as an author or editor for Emedicine-Medscape-WebMD and UpToDate; and is on the editorial boards of Medscape-WebMD, European Neurology, Epileptic Disorders, Epilepsy and Behavior, and Expert Review of Neurotherapeutics. S. Helmers has served as a consultant for Cyberonics and UCB; has received grant support from Cyberonics and UCB; and has an IPA with the CDC. L. Hirsch has received research support from UCB, Upsher-Smith, and Lundbeck; has served as a consultant to Lundbeck, Upsher-Smith, RSC Diagnostics, Neuropace, and Natus; and has received royalties from UpToDate and for coauthoring Atlas of EEG in Critical Care (John Wiley & Sons, Inc. 2010). J. Sirven has received grant support from Neuropace, Cyberonics, Eisai, and Upsher-Smith; has served as consultant for Lundbeck, Sunovion, and Upsher-Smith; has received royalties from UpToDate, LWW, and time compensation from the Epilepsy Foundation for Epilepsy.com; and serves on the editorial boards of Epilepsy & Behavior, Epilepsy Currents, and Mayo Clinic Proceedings. F. Vale reports no disclosures. J. Wheless has received grants from NH, Shainberg Foundation, GSK, Cyberonics, Eisai, Upsher-Smith, and Novartis; has served as a consultant for Lundbeck, Cyberonics, Pfizer, Eisai, Sunovion, Supernus, and Upsher-Smith; and has served on the speakers' bureau for Lundbeck, Questcor, Cyberonics, Eisai, and Supernus. Go to Neurology.org for full disclosures.
- © 2014 American Academy of Neurology
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