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Neurology. 2014 Sep 2;83(10):913-9. doi: 10.1212/WNL.0000000000000750. Epub 2014 Aug 8.

Feasibility of using an online tool to assess appropriateness for an epilepsy surgery evaluation.

Author information

1
From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., A.H., P.F., N.P., W.M., M.V., N.J.), Department of Community Health Sciences and Institute for Public Health (J.I.R., S.W., K.S., N.J.), and Department of Radiology (P.F.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Canada.
2
From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., A.H., P.F., N.P., W.M., M.V., N.J.), Department of Community Health Sciences and Institute for Public Health (J.I.R., S.W., K.S., N.J.), and Department of Radiology (P.F.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Canada. Nathalie.jette@albertahealthservices.ca.

Abstract

OBJECTIVES:

To examine the applicability of applying an online tool to determine the appropriateness of referral for an epilepsy surgical evaluation and to determine whether appropriateness scores are concordant with the clinical judgment of epilepsy specialists.

METHODS:

We prospectively applied the tool in 107 consecutive patients with focal epilepsy seen in an epilepsy outpatient clinic. Variables collected included seizure type, epilepsy duration, seizure frequency, seizure severity, number of antiepileptic drugs (AEDs) tried, AED-related side effects, and the results of investigations. Appropriateness ratings were then compared with retrospectively collected information concerning whether a surgical evaluation had been considered.

RESULTS:

Thirty-nine patients (36.4%) were rated as appropriate for an epilepsy surgical evaluation, all of whom had adequately tried 2 or more appropriate AEDs. The majority of patients (84.6%) rated as appropriate had previously been considered or referred for an epilepsy surgical evaluation. Tool feasibility of use was high, with the exception of assessing whether previous AED trials had been adequate and discrepancies between physician and patient reports of AED side effects.

CONCLUSIONS:

Our evidence-based, online clinical decision tool is easily applied and able to determine whether patients with focal epilepsy are appropriate for a surgical evaluation. Future validation of this tool will require application in clinical practice and assessment of potential improvements in patient outcomes.

PMID:
25107882
PMCID:
PMC4153845
DOI:
10.1212/WNL.0000000000000750
[Indexed for MEDLINE]
Free PMC Article

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