Journal article
Epilepsy Surgery for Pharmacoresistant Temporal Lobe Epilepsy A Decision Analysis
JAMA : the journal of the American Medical Association, v 300(21), pp 2497-2505
03 Dec 2008
PMID: 19050193
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Context Patients with pharmacoresistant epilepsy have increased mortality compared with the general population, but patients with pharmacoresistant temporal lobe epilepsy who meet criteria for surgery and who become seizure- free after anterior temporal lobe resection have reduced excess mortality vs those with persistent seizures.
Objective To quantify the potential survival benefit of anterior temporal lobe resection for patients with pharmacoresistant temporal lobe epilepsy vs continued medical management.
Design Monte Carlo simulation model that incorporates possible surgical complications and seizure status, with 10 000 runs. The model was populated with health-related quality- of- life data obtained directly from patients and data from the medical literature. Insufficient data were available to assess gamma- knife radiosurgery or vagal nerve stimulation.
Main Outcome Measures Life expectancy and quality- adjusted life expectancy.
Results Compared with medical management, anterior temporal lobe resection for a 35- year- old patient with an epileptogenic zone identified in the anterior temporal lobe would increase survival by 5.0 years ( 95% CI, 2.1- 9.2) with surgery preferred in 100% of the simulations. Anterior temporal lobe resection would increase qualityadjusted life expectancy by 7.5 quality- adjusted life- years ( 95%, CI, - 0.8 to 17.4) with surgery preferred in 96.5% of the simulations, primarily due to increased years spent without disabling seizures, thereby reducing seizure- related excess mortality and improving quality of life. The results were robust to sensitivity analyses.
Conclusion The decision analysis model suggests that on average anterior temporal lobe resection should provide substantial gains in life expectancy and qualityadjusted life expectancy for surgically eligible patients with pharmacoresistant temporal lobe epilepsy compared with medical management.
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Details
- Title
- Epilepsy Surgery for Pharmacoresistant Temporal Lobe Epilepsy A Decision Analysis
- Creators
- Hyunmi Choi - Columbia UniversityRandall L. Sell - Drexel UniversityLeslie Lenert - Ctr Dis Control & Prevent, Natl Ctr Publ Hlth Informat, Atlanta, GA USAPeter Muennig - Columbia Univ, Mailman Sch Publ Hlth, Dept Hlth Policy & Management, New York, NY USARobert R. Goodman - Columbia Univ, Dept Neurol Surg, New York, NY USAFrank G. Gilliam - Columbia Univ, Dept Neurol, New York, NY USAJohn B. Wong - Tufts Univ, Sch Med, Dept Med, Div Clin Decis Making,Tufts Med Ctr, Boston, MA 02111 USA
- Publication Details
- JAMA : the journal of the American Medical Association, v 300(21), pp 2497-2505
- Publisher
- Amer Medical Assoc
- Number of pages
- 9
- Grant note
- KL2 RR024157 / National Center for Research Resources; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Research Resources (NCRR) K24NS047551 / NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) K12RR017648 / NATIONAL CENTER FOR RESEARCH RESOURCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Research Resources (NCRR)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Community Health and Prevention
- Web of Science ID
- WOS:000261286200018
- Scopus ID
- 2-s2.0-57349144887
- Other Identifier
- 991019167974004721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology