The advice has been issued in a new consensus document, published as a Special Report in Epilepsia, which is designed to provide recommendations on the timing of referral for epilepsy surgical evaluation.
It states that even people who are seizure-free on anti-seizure medications with a resectable lesion may benefit from surgery by avoiding drug side effects.
The report said: “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 non surgical candidates through improvement in diagnosis, optimisation of therapy and treatment of comorbidities.
The ILAE 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, they reached the following Expert Consensus Recommendations:
- 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.
- 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 one to two antiseizure medications (ASMs) but have a brain lesion in noneloquent cortex.
- Referral for surgery should not be offered to patients with active substance abuse who are noncooperative with management.
