Which patients should be referred to a comprehensive epilepsy program for an epilepsy surgery evaluation?
| Indication | Comment |
|---|---|
| Any child or adult who meets the definition of drug-resistant epilepsy and has disabling seizures | Drug-resistant epilepsy: Failure of adequate trials of 2 tolerated, appropriately chosen and used antiepileptic drugs (whether as monotherapies or in combination) to achieve sustained seizure freedom. (10) |
| Children or adults with complex syndromes or requiring complex surgeries | Examples of complex syndromes: Rasmussen encephalitis, tuberous sclerosis, Sturge–Weber syndrome, Landau–Kleffner syndrome, polymicrogyria, hypothalamic hamartoma, Dravet syndrome, Lennox–Gastaut syndrome, West syndrome, Ohtahara syndrome, infantile spasms, epilepsia partialis continua. Examples of complex surgeries: hemispherectomies, multilobar resections, palliative procedures |
| Children or adults with epilepsies that cannot be clearly assigned to a known electroclinical syndrome but with stereotyped or lateralized seizures or focal findings | The International League Against Epilepsy has proposed a new classification of seizures and epilepsies. (45) |
| Children with an MRI lesion amenable to surgical removal regardless of seizure status | Recommended by the Subcommission for Pediatric Epilepsy Surgery of the International League Against Epilepsy because these children are more likely to relapse, and are at high risk of developing epileptic encephalopathy, especially at a younger age. (46) |
Modified with permission from Wiebe and Jette. (33)