Patients with Epilepsy Often Balk at Surgery
Sullivan, Michele G., Clinical Psychiatry News
BALTIMORE -Despite the very real chance of living a seizure-free life, many epilepsy patients with an excellent surgical prognosis continue to walk away from the procedures.
Researchers at the meeting agreed: It's not always easy to convince a patient with refractory seizures that removing part of his or her brain could be the best treatment option.
"Many times, you bring up the idea of surgery and see a look of shock and horror," Dr. Chad Carlson said in a press briefing. "Some are intrigued by the idea that their seizures could be reduced or even eliminated, but there is a real population who are either apprehensive or who flatly say: 'You are not taking out a piece of my brain.'"
Dr. Carlson and his colleagues categorized 445 patients with intractable seizures into three groups, using a set of clinical characteristics predictive of surgical outcome. Grade 1 patients (110) had the highest likelihood of becoming seizure free.
"What surprised us was that only 43 of these patients went on to have surgery" at the center, he said. The attrition rate for epilepsy surgery is frustrating, especially in light of the outcomes for those who did have it. 7At 18 months, 89% were completely free of seizures," Dr. Carlson said.
In a second study examining why patients refuse surgery, Dr. Christopher T. Anderson, director of the epilepsy monitoring unit at the University of Pennsylvania, Philadelphia, discussed a cohort of 32 patients, all of whom were good surgical candidates and who underwent an intensive, year-long presurgical evaluation.
The process is time consuming, expensive, and not without risk, since some of the tests are invasive. The evaluation costs up to $10,000, he added.
After completing the process, 9 of the 2.3 surgical candidates refused to go forward with the procedure. The review identified several characteristics that predicted both acceptance and rejection of surgery. The patients were an average of 48 years; their epilepsy began at a median age of 22 years. Despite having tried a median of six drugs, they continued to have up to 10 or more seizures a month.
There were some significant between-group differences, which Dr. Anderson said could be used to predict which patients eventually would accept or refuse surgery. Easily treatable psychiatric were some of the most striking. Nearly half (44%) of the refusers had anxiety and 11% had depression, compared with 4% for each disorder among the surgery group. In fact, Dr. Anderson said, most of those who accepted surgery (83%) had no psychiatric disorder.
"These problems are ones that are easily treatable, if not completely solvable," he said. …